Guest guest Posted January 14, 2008 Report Share Posted January 14, 2008 Hi Folks, I am a newbie at this billing quagmire, so it makes me a little nervous that I think I might know something that the blackbelt IMPers might not know, but here is what I have found out about Tricare and someone please correct me if they think this is wrong: There are different levels of participation with Tricare. You cannot bill Tricare without submitting any background info on yourself. You can become a Tricare recognized provider (minimal paperwork), but not be a contracted provider. (We did not have to give them our Medciare number for this.) They have their own fee schedule and we are only allowed to bill at a rate of 115% of Tricare allowable, according to the Department of Defense Appropriation Act of 1993. The cite for this is on their website: http://www.mytricare.com/Internet/tric/tri/tricare.nsf/e474d532161165f 585256ce20047b00d/85256eef00561aca85256ce60059ff1c?OpenDocument. This may be why the Tricare rep told someone on this site that they get more if they are non-par-- but it requires billing the patient. since you are allowed to bill over their " allowable " . You can become a participating provider, but I do not know much about this, except that they do require a Medicare number and hospital admitting privileges. I do not understand how Tricare for life is different from a provider persepective, and how we are supposed to know that they are Tricare for Life v. regular Tricare. I take it Tricare for life is the same as saying Medicare is your primary, Tricare is you secondary using fewer words? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 14, 2008 Report Share Posted January 14, 2008 I was a Tricare provider for the last several years. I just sent them a termination notice. My FP office is higher volume than most on this list and at last count had patients on over 300 different insurance products. Tricare was by far the worst to deal with as far as hassle factor. They have a bunch of different levels of benefits. We could never reliably figure out what to do with what they had. The pay initially wasn't to bad compared to my other payers but my nurse could spend hours trying to get the most straightforward referrals approved and trying to coordinate care for these folks in our rural area. They wouldn't cover OB sonograms without divine intervention.I had to send a patient to another state for colorectal surgery and 1 1/2 hours away for a simple ankle x-ray. I took Tricare initially to support our military families, but eventually I threw in the towel as we became the focal point of all the patient complaints about access and the nonsensical micro managing malignant HMO system that runs Tricare. Sorry to be such a downer on this important government program, but this is what government healthcare seems like to me. The AAFP urged us all to sign up, but no changes in administering this program were ever made as far as I can see.Ben Tricare Hi Folks, I am a newbie at this billing quagmire, so it makes me a little nervous that I think I might know something that the blackbelt IMPers might not know, but here is what I have found out about Tricare and someone please correct me if they think this is wrong: There are different levels of participation with Tricare. You cannot bill Tricare without submitting any background info on yourself. You can become a Tricare recognized provider (minimal paperwork), but not be a contracted provider. (We did not have to give them our Medciare number for this.) They have their own fee schedule and we are only allowed to bill at a rate of 115% of Tricare allowable, according to the Department of Defense Appropriation Act of 1993. The cite for this is on their website: http://www.mytricar e.com/Internet/ tric/tri/ tricare.nsf/ e474d532161165f 585256ce20047b00d/ 85256eef00561aca 85256ce60059ff1c ?OpenDocument. This may be why the Tricare rep told someone on this site that they get more if they are non-par-- but it requires billing the patient. since you are allowed to bill over their "allowable". You can become a participating provider, but I do not know much about this, except that they do require a Medicare number and hospital admitting privileges. I do not understand how Tricare for life is different from a provider persepective, and how we are supposed to know that they are Tricare for Life v. regular Tricare. I take it Tricare for life is the same as saying Medicare is your primary, Tricare is you secondary using fewer words? Never miss a thing. Make Yahoo your homepage. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 15, 2008 Report Share Posted January 15, 2008 , Thanks for looking into this more. Overall, the confusion seems simply to be due to a very confusing system. P.S. Never be nervous about posting stuff on this list serve. The great thing about it is that we are all learning—and with the amount of stuff out there to learn, we will never truly be experts. Thanks for your insights. Tricare Hi Folks, I am a newbie at this billing quagmire, so it makes me a little nervous that I think I might know something that the blackbelt IMPers might not know, but here is what I have found out about Tricare and someone please correct me if they think this is wrong: There are different levels of participation with Tricare. You cannot bill Tricare without submitting any background info on yourself. You can become a Tricare recognized provider (minimal paperwork), but not be a contracted provider. (We did not have to give them our Medciare number for this.) They have their own fee schedule and we are only allowed to bill at a rate of 115% of Tricare allowable, according to the Department of Defense Appropriation Act of 1993. The cite for this is on their website: http://www.mytricare.com/Internet/tric/tri/tricare.nsf/e474d532161165f 585256ce20047b00d/85256eef00561aca85256ce60059ff1c?OpenDocument. This may be why the Tricare rep told someone on this site that they get more if they are non-par-- but it requires billing the patient. since you are allowed to bill over their " allowable " . You can become a participating provider, but I do not know much about this, except that they do require a Medicare number and hospital admitting privileges. I do not understand how Tricare for life is different from a provider persepective, and how we are supposed to know that they are Tricare for Life v. regular Tricare. I take it Tricare for life is the same as saying Medicare is your primary, Tricare is you secondary using fewer words? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 15, 2008 Report Share Posted January 15, 2008 So I just became a participating Tricare provider. Wish that meant I knew more about this. I can clarify a couple little points: I don't have admitting privileges, but I am participating. They did require that I currently accept Medicare. Tricare for Life/WPS, from my perspective, is entirely different from Tricare. They have 2 separate billing arrangements -- different addresses, phone numbers, etc. -- and if you call the wrong one, they can't help you. My experience is that Tricare patients bring a " Tricare " card with them. TFL/WPS patients only bring their military ID. Haresch > > Hi Folks, > I am a newbie at this billing quagmire, so it makes me a little > nervous that I think I might know something that the blackbelt IMPers > might not know, but here is what I have found out about Tricare and > someone please correct me if they think this is wrong: > There are different levels of participation with Tricare. You > cannot bill Tricare without submitting any background info on > yourself. You can become a Tricare recognized provider (minimal > paperwork), but not be a contracted provider. (We did not have to > give them our Medciare number for this.) They have their own fee > schedule and we are only allowed to bill at a rate of 115% of Tricare > allowable, according to the Department of Defense Appropriation Act > of 1993. The cite for this is on their website: > http://www.mytricare.com/Internet/tric/tri/tricare.nsf/e474d532161165f > 585256ce20047b00d/85256eef00561aca85256ce60059ff1c?OpenDocument. > This may be why the Tricare rep told someone on this site that they > get more if they are non-par-- but it requires billing the patient. > since you are allowed to bill over their " allowable " . > You can become a participating provider, but I do not know much > about this, except that they do require a Medicare number and > hospital admitting privileges. > I do not understand how Tricare for life is different from a > provider persepective, and how we are supposed to know that they are > Tricare for Life v. regular Tricare. I take it Tricare for life is > the same as saying Medicare is your primary, Tricare is you secondary > using fewer words? > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 15, 2008 Report Share Posted January 15, 2008 i only accept tricare standard, and it's been essentially no different than any other insurance company; good enough to continue accepting.there are two other tricare programs of which i am aware; prime, which is managed care, and -for-life, which is a medicare suupplement; i accept neither of them.i am wondering if there are regional differences in tricare administration which could be responsible for ben's problems below.a potential solution might be in the form of a telephone call to one's federal representatives, and of course, emphasizing "support for our troops".LLBen Brewer wrote: I was a Tricare provider for the last several years. I just sent them a termination notice. My FP office is higher volume than most on this list and at last count had patients on over 300 different insurance products. Tricare was by far the worst to deal with as far as hassle factor. They have a bunch of different levels of benefits. We could never reliably figure out what to do with what they had. The pay initially wasn't to bad compared to my other payers but my nurse could spend hours trying to get the most straightforward referrals approved and trying to coordinate care for these folks in our rural area. They wouldn't cover OB sonograms without divine intervention.I had to send a patient to another state for colorectal surgery and 1 1/2 hours away for a simple ankle x-ray. I took Tricare initially to support our military families, but eventually I threw in the towel as we became the focal point of all the patient complaints about access and the nonsensical micro managing malignant HMO system that runs Tricare. Sorry to be such a downer on this important government program, but this is what government healthcare seems like to me. The AAFP urged us all to sign up, but no changes in administering this program were ever made as far as I can see.Ben Tricare Hi Folks, I am a newbie at this billing quagmire, so it makes me a little nervous that I think I might know something that the blackbelt IMPers might not know, but here is what I have found out about Tricare and someone please correct me if they think this is wrong: There are different levels of participation with Tricare. You cannot bill Tricare without submitting any background info on yourself. You can become a Tricare recognized provider (minimal paperwork), but not be a contracted provider. (We did not have to give them our Medciare number for this.) They have their own fee schedule and we are only allowed to bill at a rate of 115% of Tricare allowable, according to the Department of Defense Appropriation Act of 1993. The cite for this is on their website: http://www.mytricar e.com/Internet/ tric/tri/ tricare.nsf/ e474d532161165f 585256ce20047b00d/ 85256eef00561aca 85256ce60059ff1c ?OpenDocument. This may be why the Tricare rep told someone on this site that they get more if they are non-par-- but it requires billing the patient. since you are allowed to bill over their "allowable". You can become a participating provider, but I do not know much about this, except that they do require a Medicare number and hospital admitting privileges. I do not understand how Tricare for life is different from a provider persepective, and how we are supposed to know that they are Tricare for Life v. regular Tricare. I take it Tricare for life is the same as saying Medicare is your primary, Tricare is you secondary using fewer words? Never miss a thing. Make Yahoo your homepage. Be a better friend, newshound, and know-it-all with Yahoo! Mobile. Try it now. Quote Link to comment Share on other sites More sharing options...
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