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Boss Ross

Meds Claim for Tricare

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Boss Ross
 

Hello All,

 

Someone on another site asked how to file a meds  claim with Tricare and asked for a "cookbook recipe" answer. So I wrote this and sent it to him. There may be others that want to know one way of doing this so I decided to post it here. Hopes it helps someone.

 

Meds Claim Instructions (the way I do it, not necessarily the only or best way)

 

* You need a DMDC (this is the best one but it takes about a month or more to get it in the mail IF you have a RAO membership or even longer if you have your password sent to you through PI mail)  or  a  tricare-overseas.com  user name and password

 

* go to  Tricare-Overseas.com 

* click Beneficiaries

* scroll down - see Secure Login on the left - click login

* login with DMDC or tricare user name and password

If you don’t have either one - follow the instructions there to get one. DMDC is the best  one.

 

How to get a user name and password:

 

To get started you need a User name and Password. Here is how you do it:

* go to tricare-overseas.com

* click on Beneficiaries

* scroll down to Secure Log In, you will see it on the left

* click register

* There you will see registration for DMDC and tricare. Both of them send you your password through the mail. DMDC is better because you can use that same password for other government sites. Register for one of them

 

 

*once logged in on the Beneficiaries page, scroll down - see Contact Customers Service - click on  Send/View Secure Message

*click on New Message

 

* choose OTHER and type CLAIM in the space

 

* in the Question/Issue box type - Claim for Meds

 

* see - Each attachment can be a max of 5 MB etc. Click  on “Click Here” and it will give you a list of allowed type of attachments.

 

* If you have many receipts you will need to scan them onto your computer all together in one page. There is only room for 3 attachments, so I put all the receipts together.  Attach your receipts, your signed and dated DD Form 2642, and your spent letter (I don't think it is required but I make a letter each time ( I use the same letter each time, just change date and meds bought) that shows my name SSAN, doctor and what I spent on what. I call it SPENT  It mostly helps me know what refund I will get, but it also covers any questions they might have too.

 

 

 

 

 

 

 

 

 

 

Tricare, 11 Jun 2015

 

Here is a list of all the insulin, needles and meds I have bought. The prescription written for these meds is in the claim package. They are written by doctors name, MD, a licensed American doctor. This was all purchased at a Tricare Approved pharmacy at the time of purchase. We do not have a phone here in the Philippines so all communication needs to be done through [email protected]  Please, if there is any more information you need, contact me through my email address. All amounts are in Philippine peso. I would like to be reimbursed in US Dollars.

 

ALL RECEIPTS ARE FOR PATIENT/SPONSOR

Ross M Best xxx-xx-xxxx (SSAN)

 

 

  

Receipt 1 Novorpd fpn 3ml   5 @ 775.00   3875.00

               Lantus vial 100IU                      2590.00

              BD M-F+pen needle   4 @ 14.50     79.50

                                                                  6544.50

 

P6544.50 = approx $152.20 refund

_________________________________________________________________________         

 

That is it, just click send. You will get a confirmation email saying they got it. Then about 30 days later a check will be mailed or an electronic transfer (automated direct deposit) will be made to your bank depending on which option you choose. Until they started electronic transfer, I had my checks mailed to my bank and my bank agreed to deposit them into my account for me. 

 

* to sign up for automated  direct deposit is now easy. Once you have an account, go to the Beneficiaries page. About 1/3 way down the page (right under the first orange stripe) see “Automated direct deposit is now here.” Click on the “click here” and follow the instructions.

 

Jim from the Retired blog says;

 

If you plan to do a lot of claims filing you might want to consider using an online faxing company that operates in the U.S. as there is less chance of loss and they get there faster.

Also you mentioned issues with mail and checks. There are two options. One sign up with the RAO in Manila and use FPO mailing. They will courier your mail to you. Two sign up with the TRICARE claims contractor for direct deposit to your U.S. account. You can do it online once you have an account with them. To do that follow the instructions under Secure Login, Register, and they will mail you a document which allows you to access their webpage the first time.http://www.tricare-overseas.com/Beneficiaries.htm Alternately you may be able to register for direct deposit by calling them. However having access to the website allows you to monitor your claims and access your EOBs as soon as the claim is final.

 

Ross

 

 

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sugbu777

Great info for those eligible to use TRICARE in the Philippines.

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NOSOCALPINOY

Yes, good info! I did my pharmacy claims just this past Feb and did it as Jim described and got my refund in about 30 days direct deposited into our bank in N. Calif. 

We usually save 12 months worth of our double pharmacy receipts from our Mercury Drug Store just across the street from where we live and I fax both of our claims to WPS once a year. Prescriptions can come from any doctor, but the meds have to be bought from an approved TRICARE pharmacy like Mercury and TRICARE WPS will accept them. Make sure you scan your receipts onto your hard drive, because the original receipts tend to fad over time. I have an on-line fax service for only $9.99 a month which provides 300 pages of fax a month, which is more than enough pages of fax we need a year.

I go on-line to the TRICARE website and check the status of our claims. I submitted $2,100 worth of pharmacy claims just for myself this past Feb and the refund amount directed deposited into our bank account was around $1,500, pretty much the same amount from previous years. 

Yeah, it seems TRICARE overseas claims has gotten better over the years. 

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Boss Ross

You said: Make sure you scan your receipts onto your hard drive, because the original receipts tend to fad over time. Very Good Point!! I forgot to put that in, here is what I said:

 

Do you have a scanner? You need to make sure you keep at least a copy of your receipts. You may not have noticed but if you have a cash register receipt, so of them will start to fade and eventually become nearly blank and unreadable. Make copies of all these type receipts Right Away! Once you have your password you will be able to file through email. This is when you will definitely need a scanner or access to one. You will need to scan the receipts to your computer if you have a scanner. If no scanner, use someone else's and scan them to a memory stick or some other storage device. Make sure you save them in one of the allowed formats. I use PDF.

 

Thanks for the good added info NOSO

 

 

Yes, good info! I did my pharmacy claims just this past Feb and did it as Jim described and got my refund in about 30 days direct deposited into our bank in N. Calif. 

We usually save 12 months worth of our double pharmacy receipts from our Mercury Drug Store just across the street from where we live and I fax both of our claims to WPS once a year. Prescriptions can come from any doctor, but the meds have to be bought from an approved TRICARE pharmacy like Mercury and TRICARE WPS will accept them. Make sure you scan your receipts onto your hard drive, because the original receipts tend to fad over time. I have an on-line fax service for only $9.99 a month which provides 300 pages of fax a month, which is more than enough pages of fax we need a year.

I go on-line to the TRICARE website and check the status of our claims. I submitted $2,100 worth of pharmacy claims just for myself this past Feb and the refund amount directed deposited into our bank account was around $1,500, pretty much the same amount from previous years. 

Yeah, it seems TRICARE overseas claims has gotten better over the years. 

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BobBski

Great information, thanks for the post.

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gasturbine

Not complete information. If you have major issues like surgery, cancer treatment , heart issues Tricare will not process your claim unless you break down each and every medical step, provide each steps CPT code and provide allowed Medicare charges for each medical procedure.  Also Tricare will not pay for durable medical equipment purchased in the USA and forwarded to Philippines.  Presently I am in Tricare Hell truing to get Tricare to pay for durable medical supplies purchased in the USA. 

 

I have a Army retired friend who had bladder cancer surgery and followed the steps in this post. His claim was for php 550000. Tricare paid him $1000.00 a long way from the 75% payment he was supposed to receive. Unless you can code claims and access Medicare allowed charges you are going to lose money. In 2012  I was treated for prostrate cancer at St. Lukes Manila cost php367000. I had a friend the late Bob Lowe help me with processing the claim .  I took us over 3 months to break the clam down into CPT codes ,allowed MEdicare charges and breakdown the professional fees into step by step coded medical procedures. I did get the full 75% reimbursement however. But it takes much more than just filling out the Tricare processors sheet.  My 2 centavos

 

Gasturbine

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Salty Dog
1 hour ago, gasturbine said:

Not complete information. If you have major issues like surgery, cancer treatment , heart issues Tricare will not process your claim unless you break down each and every medical step, provide each steps CPT code and provide allowed Medicare charges for each medical procedure.  Also Tricare will not pay for durable medical equipment purchased in the USA and forwarded to Philippines.  Presently I am in Tricare Hell truing to get Tricare to pay for durable medical supplies purchased in the USA. 

 

I have a Army retired friend who had bladder cancer surgery and followed the steps in this post. His claim was for php 550000. Tricare paid him $1000.00 a long way from the 75% payment he was supposed to receive. Unless you can code claims and access Medicare allowed charges you are going to lose money. In 2012  I was treated for prostrate cancer at St. Lukes Manila cost php367000. I had a friend the late Bob Lowe help me with processing the claim .  I took us over 3 months to break the clam down into CPT codes ,allowed MEdicare charges and breakdown the professional fees into step by step coded medical procedures. I did get the full 75% reimbursement however. But it takes much more than just filling out the Tricare processors sheet.  My 2 centavos

 

Gasturbine

This thread is about TRICARE Claims for Meds, not medical care.

However to add to what you've posted. My TRICARE Claim was around $30,000 and they paid nearly all of it as you can see below. I did not do any of the things you mentioned here in regards to coding. All I sent TRICARE was the printout of charges from the hospital along with receipts for payment. Maybe the hospital in Dumaguete just happened to have done all of this, but I doubt it. Granted this was over 5 years ago. However, I'm not aware of any major changes to the claims process since then.

Hospital and Doctors Bill P1,357,000+

Capture.JPG

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Jim_in_Jax
59 minutes ago, Salty Dog said:

This thread is about TRICARE Claims for Meds, not medical care.

However to add to what you've posted. My TRICARE Claim was around $30,000 and they paid nearly all of it as you can see below. I did not do any of the things you mentioned here in regards to coding. All I sent TRICARE was the printout of charges from the hospital along with receipts for payment. Maybe the hospital in Dumaguete just happened to have done all of this, but I doubt it. Granted this was over 5 years ago. However, I'm not aware of any major changes to the claims process since then.

 

Man I hope it's still the same.  I just submitted a claim for hospitalization for my wife and really need to get the maximum return on it because she has to go in for another surgery within a month.  I know it won't be paid right away but knowing it will be paid means a lot since her illnesses have wiped us out.

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urbanrrc

As far as all the pain Ross mentioned in getting the password.  If you have a MyPay account, you can get passwords to things like ebenefits and DMDC.  I can't walk you through the procedures because once you have your passwords if you try to get a new one, the system will tell you "that you already have one." Here is why having a Mypay password unlocks many things for you.  DoD which controls access to all these sites (including ebenefits which is mostly a VA system) treats security seriously.  However, once you have obtained a My Pay password/account, then essentially you have been vetted by DoD, and they then allow you to get to all these other systems without waiting for the mail for passwords. The problem with waiting for password in mail is that if the letter arrives more than 30 days after it was issued, the password has expired.  Avoid all that nonsense and use My pay as your entry way into all these other systems.

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Salty Dog
7 hours ago, Jim_in_Jax said:

Man I hope it's still the same.  I just submitted a claim for hospitalization for my wife and really need to get the maximum return on it because she has to go in for another surgery within a month.  I know it won't be paid right away but knowing it will be paid means a lot since her illnesses have wiped us out.

Mine took a couple of months, but that was because when the claim was sent in, there was an error in my social security number so the computer kicked it back. 

Here is a thread about my experiences.

 

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gasturbine

I really hope I am wrong in my post and Salty Dog is correct.  However the post concerning my friends Tricare experience is fact. How did Tricare deal with the professional fees? Normally they are the major issue when seeking Tricare reimbursement. I always go to Manila for major issues and use the excellent demo  project at the Medical City. Only 25% of billed charges are required from the patient up to $3000 yearly , then 100% paid for by Tricare. This plan is at Makati Medical Center and Asian Hospital as well.  The plan is excellent and has paid well over php 1000000 in medical care for me. I really only trust these big JCAHO certified hospitals in Manila for major issues as the smaller hospitals are mediocre at best. Even the large Manila hospitals  fall far short of the average US hospital.  If its serious go to Manila is sound advice.

 Has anyone purchased durable medical equipment from the USA for use here in Philippines?  I just asked because I am in a fight with Tricare to pay for test strips for my coumadin blood levels tester. They forwarded claim too Tricare for life which of course has nothing to do with us here in Philippines. Won't pay because equipment was purchased in the USA not Philippines.  This is an ongoing issue with Tricare. Sometimes they pay these claims and sometimes they don't.  We will see what happens. 

 

Gasturbine

 

 

 

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Salty Dog
5 minutes ago, gasturbine said:

They forwarded claim too Tricare for life which of course has nothing to do with us here in Philippines.

Actually TFL does affect some members in the Philippines. If you're over 65 you have to pay Medicare Part B to continue to keep TRICARE Overseas. That automatically puts you in TFL as well. If you returned to the USA you would use Medicare and TFL. If you purchased services or equipment in the USA, seems that TFL would be the one who pays. However, if the services and/or equipment are approved, between Medicare and TFL, your expenses would be covered 100%.

The reason that you might be having issues is that Medicare has to pay first and then they forward it to TFL for payment. If it was sent directly to TFL, they will decline it. Yes I know that Medicare will not cover you out of the country, but if you purchased equipment in the USA, it should pay if it was approved equipment.

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gasturbine

Jim Jax seems to me you should go to Manila for your wifes care. Then you would not have to pay big money out of pocket for her care. Go to the Medical City International Office and they will provide necessary doctors and you will pay only 25% of charges up to $3000.  You can stay at the Red Planet Ortigas Hotel for php 1500 daily and are only a php78 from the  Medical City Hospital.  I stayed at the red planet for 2 weeks when I had thyroid surgery that cost php 717000. I paid out of pocket only php 129000.  Of course if you choose this option travel cost and living expenses will be required. Still they are much cheaper than a large medical bill. You would probably only need a few days as The Medical City is quite efficient and the medical care is first class.   FYI

Edited by gasturbine
left out info
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gasturbine

Thanks Salty Dog maybe I am wrong when I think Tricare Overseas pays. Maybe I have to drop back and punt. However spoke to Tricare for Life and they wanted information concerning the medical equipment that is not provided here in Philippines.  Like How often do I do the testing .   I will investigate. Thanks

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RogerDat

I am surprised you can get test strips here for that meter. my blood sugar tester is US, and the VA gave it to me, and issue strips yearly, but the same brand tester here will not work with US test strips. I had a coagulation test done because of blood thiners before surgery, but that is a one time test before each procedure. Hospital charged me about p700 for it.

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gasturbine

Rogerdat you can get glucose meter and test strips at Mercury drugs or Rose pharmacy here in Cebu.

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RogerDat

Yes, you can, but the VA issues mine. The local and US meters and test strips same brand are not compatible, in fact my VA test strips say not for sale, so I think they will not work with a commercial US meter.

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