Question

Why do the medical insurance billers need to understand DEERS for TRICARE?

Who is responsible for the payment for a workers’ compensation case?

Why are separate medical records necessary for workers’ compensation?

Answer 1

What Is TRICARE?

TRICARE is the worldwide health care program available to eligible beneficiaries of the seven uniformed services – the Army, U.S. Navy, U.S. Air Force, U.S. Marine Corps, U.S. Coast Guard, Commissioned Corps of the U.S. Public Health Service, and the Commissioned Corps of the National Oceanic and Atmospheric Administration. TRICARE-eligible beneficiaries may include active duty service members and their families, retired service members and their families, National Guard and Reserve members and their families, survivors, certain former spouses, and others.TRICARE brings together military and civilian health care professionals and resources to provide high-quality health care services. TRICARE is managed in two stateside regions in the U.S – TRICARE East and TRICARE West. In these U.S. regions, TRICARE is jointly managed by the Defense Health Agency (DHA) and the TRICARE Health Plan. The DHA has partnered with civilian regional contractors in the East and West regions to assist TRICARE regional directors, and military hospital and clinic commanders in operating an integrated health care delivery system.TRICARE is available worldwide to eligible beneficiaries, including ADSMs and their families, retired service members and their families, National Guard and Reserve members and their families, survivors, certain former spouses and others, from any of the seven uniformed services – the U.S. Army, U.S. Navy, U.S. Air Force, U.S. Marine Corps, U.S. Coast Guard, the Commissioned Corps of the U.S. Public Health Service and the Commissioned Corps of the National Oceanic and Atmospheric Administration. All beneficiaries must register in the Defense Enrollment Eligibility Reporting System (DEERS) to be eligible for TRICARE.

A CAC or ID card alone does not prove TRICARE eligibility.
All eligibility is based on the Defense Enrollment Eligibility
Reporting System (DEERS). Beneficiaries can verify their
eligibility in DEERS by calling 1-800-538-9552. Providers must verify the beneficiary’s TRICARE eligibility online through www.tricare-west.com or through the interactive voice
response (IVR) system. Use the sponsor’s Social Security number or Department of Defense (DoD) Benefits Number to verify eligibility. If you are verifying online, retain a printout of the eligibility verification screen for your files.Newborns and adopted children must be registered in DEERS within 365 days of birth or adoption or DEERS will show “loss of eligibility.” After this time period, newborns and adopted children will no longer be able to receive TRICARE benefits until registered in DEERS. Some TRICARE programs and adopted children will no longer be able to receive TRICARE benefits until registered in DEERS. Some TRICARE programs require enrollment. This is separate from registration in DEERS.

B. Debt Collection Assistance Officers (DCAOs) are located at each TRICARE Regional Office and military hospital or clinic to assist TRICARE beneficiaries with collection-related issues. The DCAO cannot provide beneficiaries with legal advice or fix their credit ratings, but DCAOs can help beneficiaries through the debt collection process by providing documentation for the collection or credit reporting agency in explaining the circumstances relating to the debt.

C. HNFS may review your medical records on a random basis to evaluate patterns of care and compliance with performance standards. Each provider should have policies and procedures in place to help ensure that the information in each patient’s medical record is kept confidential and is appropriately organized. The medical record must contain information to justify admission and continued hospitalization, support the diagnosis and describe the patient’s progress and response to medications and services.