CAS3
04-07-04, 03:31 PM
All beneficiaries who are eligible for TRICARE For Life, including those under age 65 and dual-eligible for TRICARE and Medicare, will soon receive a letter from Wisconsin Physicians Service (WPS), the new TRICARE For Life claims processor. Beginning April 1, 2004, WPS will be phased in as the new centralized claims processor for all TRICARE regions and the approximately 1.7 million TRICARE For Life beneficiaries in the United States, Puerto Rico, Guam, the U.S. Virgin Islands, the American Samoan Islands and the North Mariana Islands. The introductory letter contains contact information and frequently asked questions on TRICARE For Life, WPS and the automated claims processing system that services all TRICARE For Life beneficiaries.
The new contract integrates the services previously provided by each of the regional managed care support contractors, providing a single source for claims processing, customer service and administrative claims services. The WPS TRICARE For Life (WPS TFL) contract is part of the Department of Defense's next generation of contracts and is designed to optimize the delivery of claims and associated customer services. "The new single claims processing vehicle will deliver customer-friendly service and improve beneficiaries' satisfaction," said Rear Admiral Richard A. Mayo, Deputy Director of TRICARE Management Activity. "We will employ commercial best practices and an effective management approach to provide the necessary services through this world-class claims processing system."
TFL claims processing is currently in a state of transition. The outgoing regional claims processor will continue to process claims for services beneficiaries receive until WPS TFL is implemented in the beneficiary's state. For information about current claims processors and to find out what region a beneficiary is in, see www.tricare.osd.mil/main/chart.html.
WPS TFL is being phased in as follows:
Region 11: April 1, 2004
Regions 2/5: June 1, 2004
Regions 9/10/12: July 1, 2004
Regions 3/4: August 1, 2004
Region 1: September 1, 2004
Regions 7/8 (Central): October 1, 2004
Region 6: November 1, 2004
Because the Medicare program is administered on a state-by-state basis, WPS TFL will be implemented by state. In cases when parts of a state are included under two separate regions, WPS TFL will be implemented when the largest part of a state is scheduled to be implemented. For example, Idaho falls under Region 7/8 (Central) and Northern Idaho falls under Region 11; all of Idaho will be phased in with Region 7/8 (Central). A complete list of states' phase in dates will soon be available on www.tricare.osd.mil.
On the above implementation dates, beneficiaries who are under age 65 and are eligible for both Medicare and TRICARE due to disability or end-stage renal disease will no longer need to directly file claims to a managed care support contractor. All claims filed with Medicare for these dual-eligible beneficiaries will go to WPS TFL. WPS has agreements with each Medicare carrier allowing Medicare to directly submit claims to WPS TFL once implemented in the state. If the provider currently submits claims electronically on the beneficiary's behalf to Medicare, Medicare will now submit this claim directly to WPS TFL. Beneficiaries will receive an Explanation of Benefits (EOB) from WPS TFL once processing has been completed.
Once implemented in a region, beneficiaries may call WPS TFL, (866) 773-0404 or TDD (866) 773-0405 for information and/or claims processing assistance. For more information, go to http://www.tricare.osd.mil/faqs/default.aspx; under "Word Search" type in "TRICARE For Life" or under the "Advanced Search" use the drop down menu, and choose category "TRICARE For Life/Dual eligible", subcategory "All" and then hit "GO". Beneficiaries may also access TRICARE For Life information on the TRICARE Web site at www.tricare.osd.mil/tfl and on the WPS Web site at www.tricare4u.com.
The new contract integrates the services previously provided by each of the regional managed care support contractors, providing a single source for claims processing, customer service and administrative claims services. The WPS TRICARE For Life (WPS TFL) contract is part of the Department of Defense's next generation of contracts and is designed to optimize the delivery of claims and associated customer services. "The new single claims processing vehicle will deliver customer-friendly service and improve beneficiaries' satisfaction," said Rear Admiral Richard A. Mayo, Deputy Director of TRICARE Management Activity. "We will employ commercial best practices and an effective management approach to provide the necessary services through this world-class claims processing system."
TFL claims processing is currently in a state of transition. The outgoing regional claims processor will continue to process claims for services beneficiaries receive until WPS TFL is implemented in the beneficiary's state. For information about current claims processors and to find out what region a beneficiary is in, see www.tricare.osd.mil/main/chart.html.
WPS TFL is being phased in as follows:
Region 11: April 1, 2004
Regions 2/5: June 1, 2004
Regions 9/10/12: July 1, 2004
Regions 3/4: August 1, 2004
Region 1: September 1, 2004
Regions 7/8 (Central): October 1, 2004
Region 6: November 1, 2004
Because the Medicare program is administered on a state-by-state basis, WPS TFL will be implemented by state. In cases when parts of a state are included under two separate regions, WPS TFL will be implemented when the largest part of a state is scheduled to be implemented. For example, Idaho falls under Region 7/8 (Central) and Northern Idaho falls under Region 11; all of Idaho will be phased in with Region 7/8 (Central). A complete list of states' phase in dates will soon be available on www.tricare.osd.mil.
On the above implementation dates, beneficiaries who are under age 65 and are eligible for both Medicare and TRICARE due to disability or end-stage renal disease will no longer need to directly file claims to a managed care support contractor. All claims filed with Medicare for these dual-eligible beneficiaries will go to WPS TFL. WPS has agreements with each Medicare carrier allowing Medicare to directly submit claims to WPS TFL once implemented in the state. If the provider currently submits claims electronically on the beneficiary's behalf to Medicare, Medicare will now submit this claim directly to WPS TFL. Beneficiaries will receive an Explanation of Benefits (EOB) from WPS TFL once processing has been completed.
Once implemented in a region, beneficiaries may call WPS TFL, (866) 773-0404 or TDD (866) 773-0405 for information and/or claims processing assistance. For more information, go to http://www.tricare.osd.mil/faqs/default.aspx; under "Word Search" type in "TRICARE For Life" or under the "Advanced Search" use the drop down menu, and choose category "TRICARE For Life/Dual eligible", subcategory "All" and then hit "GO". Beneficiaries may also access TRICARE For Life information on the TRICARE Web site at www.tricare.osd.mil/tfl and on the WPS Web site at www.tricare4u.com.