Get Tricare Overseas Program Claim Development Worksheet
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How to fill out the Tricare Overseas Program Claim Development Worksheet online
Filling out the Tricare Overseas Program Claim Development Worksheet is a crucial step in managing your medical reimbursement claims while overseas. This guide will provide you with clear instructions on each section of the form to ensure a smooth submission process.
Follow the steps to complete the Tricare Overseas Program Claim Development Worksheet online.
- Press the ‘Get Form’ button to obtain the form and open it in your preferred editor.
- In the 'Patient Details' section, enter the authorization number, full name, date of birth (YYYYMMDD format), address, gender, sponsor's Social Security Number (SSN) or DOD Benefits Number (DBN), sponsor's name, and your relationship to the sponsor.
- Sign and date the 'Patient Signature' section. Ensure that the date is in YYYYMMDD format. This signature certifies that the information in Part One is correct.
- In the 'Diagnosis' section, describe the condition for which treatment was received. If applicable, include the diagnosis code (ICD-9 or ICD-10).
- Indicate whether emergency care was received by selecting 'Yes' or 'No'.
- Enter the patient account number or invoice number in the 'Patient Account Number' section to help reconcile claim payments.
- In the 'Other Health Insurance' section, indicate if the patient has other health insurance by selecting 'Yes' or 'No'. If 'Yes', provide the name of the other insurance, the insured party's name, policy number, effective dates, and the amount paid by the other insurance.
- Record any payments made by the beneficiary under the 'Beneficiary Payments' section, including the total amount paid and currency.
- Complete the 'Provider Details' section by entering the provider’s name and address.
- The provider must sign and date the 'Provider Signature' section with the date in YYYYMMDD format.
- Once all sections are complete, you can save changes, download, print, or share the form as needed.
Complete your Tricare Overseas Program Claim Development Worksheet online today for efficient claims processing.
You need to send TRICARE claims to the address indicated in the TRICARE Overseas Program Claim Development Worksheet. It's vital to ensure you are sending your claims to the correct location based on your service type. Reviewing detailed instructions provided in the worksheet will help you confirm the right address. Proper submission is key to ensuring your claim is processed efficiently.
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