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Glitch Forces Some to File Own TRICARE for Life Claims

By Sgt. 1st Class Kathleen T. Rhem, USA
American Forces Press Service

WASHINGTON, Nov. 9, 2001 – A paperwork error caused the names of some 195,000 TRICARE For Life beneficiaries to not be provided to Medicare claims processors to allow for automatic claims processing.

Steve Lillie, TRICARE's director of over-65 benefits, said the names of roughly 13 percent of eligible TRICARE for Life beneficiaries didn't get "matched up" with their files in the Medicare rolls. He said they're still eligible for benefits, but they may have to take one extra step for the time being: They may have to file TRICARE claims themselves if they received care after Oct. 1 and the provider sends a bill for what remains after Medicare has paid its share.

Ideally, the TRICARE and Medicare databases would be synched so claims for anything not covered by Medicare are automatically forwarded to TRICARE. The bill-paying process would be invisible to beneficiaries.

Lillie said the databases don't match because of the mistake, so Medicare isn't forwarding some claims to TRICARE. Healthcare providers might send affected beneficiaries bills from unpaid amounts.

TRICARE expects to send affected beneficiaries letters by mid-month explaining the problem and telling them how best to handle it. Lillie recommended beneficiaries who receive bills contact their healthcare providers' billing office and explain the problem.

The billing office can then submit the claim directly to TRICARE. Alternatively, the beneficiary can file the claim with TRICARE. The beneficiary still won't have to pay for things covered by TRICARE, Lillie said.

Two specific groups were affected by this problem. The smaller group includes about 10,600 survivors of people who died on active duty.

The rest are people who updated their Medicare status in the Defense Eligibility Enrollment Reporting System themselves. Lillie explained that DEERS is the way DoD keeps track of who is eligible for what benefits. DEERS and Medicare exchanged data in July so that all the people eligible for TRICARE for Life would be listed as such in the Medicare databases.

"People who had updated their information ... with the best of intentions accidentally got left out of the submission to Medicare," Lillie said. Apparently these names weren't sent to Medicare to cross-check for eligibility because DEERS had already verified their Medicare enrollment status, he said.

The problem will be resolved by Dec. 1. All claims submitted to Medicare after Dec. 1 -- even for care received before Dec. 1 -- will automatically be forwarded to TRICARE, he said. On the other hand, healthcare claims won't go to TRICARE automatically if providers submit them from Oct. 1 up until the problem is corrected, he added.

TRICARE officials noticed the problem in mid-October during a routine overview of the program and immediately took steps to correct it. Defense Department officials are also discussing the matter with officials from the American Medical Association to determine if there's a way to make healthcare providers aware of the temporary situation.

"The key emphasis is it's a temporary glitch. The claim will be paid," Lillie said. "It's not what we wanted to happen, but we anticipated a few problems with start up. This happens to have affected more people than we would have liked. But it will be fixed pretty quickly."

There are several avenues available to individuals seeking more information or experiencing problems with TRICARE for Life, Lillie explained. They can call TRICARE's main helpline at 1-888-DOD-LIFE, visit any regional beneficiary assistance office, or visit the TRICARE Web site at www.tricare.osd.mil.

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