In light of the post below, the VFW's alert regarding the VA looking at adopting TRICARE-like billing practices for service-connected veterans, I thought I'd include this bit on how it works with TRICARE, which I suspect is at least the base model that the VA is looking at. From the TRICARE blog at www.health.mil, an official source:
TRICARE & OHI: All beneficiaries should understand their Tricare benefit, which includes how Tricare pays claims for beneficiaries who have other health insurance (OHI). Understanding how the two work together is necessary for ensuring timely and accurate claims processing. Basically, other health insurance or health care coverage beneficiaries have in addition to Tricare. Beneficiaries may be eligible for OHI through an employer, private insurer, school health care coverage or entitlement programs such as Medicare. Navigating two health care plans can be quite confusing at first. The most important thing to remember if you have OHI is that, by law, your OHI is the primary payer, and Tricare is secondary. You or your provider must file health care claims with your primary health insurance before you file with Tricare. Check with your OHI provider and your regional contractor to find out the appropriate steps to take to ensure your claims are paid. Refer to Tricare’s OHI page or OHI Claims Flyer for more information. You may also want to visit the Tricare Web site on working with Tricare and Medicare at www.military.com/benefits/tricare/tricare-and-medicare for specific information.
A key to managing more than one plan is to keep Tricare in the loop. Denials or delays in processing are likely if a beneficiary does not inform their appropriate Tricare contacts about their OHI. First of all, make sure your doctor knows that you have OHI. If your doctor fills out your claim incorrectly, this may delay processing. Secondly, for your pharmacy benefit, let Tricare know about your OHI by calling the Tricare pharmacy contractor, Express Scripts, Inc. (ESI) at 1-866-DoD-TRRx (1-866-363-8779). Lastly, each Tricare region has an OHI Questionnaire to help you communicate any changes which can be accessed at:
• North Region
• South Region
• West Region
For Tricare For Life (TFL) beneficiaries, Medicare pays first, then your OHI, then Tricare. In most cases, you will need to file the claim with Tricare and include your explanation of benefits after your OHI pays its share. You can find more information on how OHI and TFL work together at http://tricare.mil/mybenefit/home/overview/Plans/ForLife/OtherHealthInsurance . Remember to notify TFL that you have OHI with the TFL OHI Questionnaire.
National Health Insurance Programs - These overseas programs are considered OHI. If you are enrolled in such programs, seek guidance from your appropriate overseas Tricare Service Center (TSC) before obtaining health care from a host nation provider at:
• Tricare Area Office-Latin America and Canada -- TAO-LAC, Building 38716, 38th Alley, Ft Gordon, GA 30905-5650 or email taolac@tma.osd.mil or Tel: 1-888-777-8343(no charge); 1-706-787-2424; DSN: 773-2424; Fax: 1-706-787-3024.
• Tricare Area Office-Pacific -- email: TPAO.CSC@oki10.med.navy.mil or Tel: 1-888-777-8343 (no charge); 011-81-6117-43-2036; DSN: 643-2036; Remote Sites: 011-65-6-338-9277; Fax: 011-81-611-743-2037 or DSN 643-2037.
• Tricare Area Office-Europe -- email teurope@europe.tricare.osd.mil or Tel: 1-888-777-8343 (no charge); 011-49-6302-67-7432; DSN: 496-7432; Fax: 011-49-6302-67-6374 or DSN 496-6374.
Supplemental Insurance Programs - Keep in mind that “supplemental” insurance programs are different than OHI plans. “Supplemental” plans are offered for purchase by some military associations and private companies, and do not fall under OHI rules. Visit the Tricare Web site http://tricare.mil/mybenefit to learn more about “supplemental” plans. For questions about Tricare benefits and services refer to www.tricare.mil/contactus . [Source: Tricare Blog www.health.mil/tmablog/default.aspx 2 Mar 098 ++]
