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TRICARE For Life

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Important Notice Regarding Change in Timely Filing of TRICARE Claims for Participating Provider Claims.

TRICARE requires that all claims for benefits must be filed with the appropriate TRICARE contractor no later than one year after the date the services were provided or one year from the date of discharge for an inpatient admission for facility charges billed by the facility. Professional services billed by the facility must be submitted within one year from the date of service.

Effective February 1, 2010, the claims filing deadline also applies to claims submitted by participating providers. Previously the claims filing deadline was only applied to claims submitted by non-participating providers or TRICARE beneficiaries. In accordance with the TRICARE Operations Manual, Chapter 8, Section 3, there are limited circumstances in which the contractor may waive the claims filing deadline. All requests for exceptions to the claims filing deadline must be submitted in writing.

Please submit all outstanding TRICARE for Life claims prior to the one year filing limit.

For more information, please refer to the TRICARE Operations Manual at http://manuals.tricare.osd.mil/.

Prior Authorization Requirements for TRICARE for Life Beneficiaries

Prior authorization is required for some services when TRICARE for Life (TFL) is the primary payer instead of Medicare.

All services listed below must be reviewed by WPS/Tricare for Life (TFL) for medical necessity and require prior authorization when TRICARE is primary payer instead of Medicare. As secondary payer to Medicare, WPS/TFL will rely on Medicare's determination and NO authorization is required.

If you have authorization from a TRICARE Managed Care Support Contractor (Triwest, Humana or Health Net Federal Services) that cover the dates on your claim, we will honor those authorizations and NO TFL authorization is required. A ten percent payment reduction will apply to a provider's failure to obtain a required authorization.

  • Adjunctive dental care
  • Dental anesthesia and institutional care
  • Inpatient mental health services
  • Partial Hospitalization
  • Psychoanalysis
  • All outpatient psychotherapy after the first 8 sessions in a fiscal year
  • Organ and stem cell transplants
  • Hospice
  • Extended Care Health Option (ECHO).

Please have the provider fill out the Service Request Notification Form and submit to the fax number given in the top right corner of the form.

Go Green - Reduce your Carbon Footprint

Did you know WPS allows you to suppress your paper Explanation of Benefits (EOB's)?

You have the option to receive an immediate email notification each time your TRICARE for Life claim has processed. The email notification will provide a link allowing you the convenience to view and print your TRICARE for Life EOB from your own home instead of receiving the monthly summary EOB in the mail.

You can receive this electronic notification by registering on TRICARE4u.com. Registering is easy and only takes a few minutes. Simply click 'Register as a Beneficiary' to get started During the registration process select yes to suppress your paper EOB. You will receive the email notification and will no longer receive a TRICARE for Life EOB in the mail.

It is fast and easy to sign up and by suppressing paper mailings you have a direct positive impact on the environment.