After Sept. 1, 2002, claims for beneficiaries who are not shown as eligible in DEERS will be denied and will no longer be sent electronically from Medicare to TRICARE for payment. These beneficiaries will be responsible for paying for services that Medicare does not cover.

Claims received for beneficiaries with expired eligibility will continue to be denied until their eligibility information is updated. By law, DoD must recoup (take back) payments made to ineligible persons.

"We urge beneficiaries to contact DMDC and update their eligibility in DEERS so they may continue to take advantage of this incredible benefit. We want to ensure that they have every opportunity to update their eligibility and use TRICARE For Life," explained Dr. William Winkenwerder, the Assistant Secretary of Defense for Health Affairs. TRICARE For Life beneficiaries who need to update or re-verify eligibility, or beneficiaries who have received an Explanation of Benefits (EOB) stating that they need to update their eligibility, should contact the nearest ID card facility for assistance.
The Web site developed to help beneficiaries locate the nearest ID card facilities is ID CARDS   at http://www.dmc.osd.mil/.

Beneficiaries also may call the DoD Benefits Reverification Telephone Center at 1-800-361-2620.

OHI Indicator (Other Health Insurance)

TRICARE FOR LIFE is unique because it actually requires beneficiaries to be enrolled in OHI, in this case, Medicare Parts A and B. Medicare is the federal health insurance program for people age 65 and older, and people below the age of 65 who are disabled or have End-Stage Renal Disease. Medicare Part A is provided automatically to people age 65 and older that are eligible for Social Security retirement benefits, and pay for inpatient hospital stays, care in a skilled nursing facility, hospice care and some home health care. Medicare Part B is a voluntary program, which requires beneficiaries to pay a monthly premium, and helps pay for doctors’ services, outpatient hospital care, and some other medical services that Part A does not cover, such as the services of physical and occupational therapists, and some home health care.

Beneficiary Notification Failure.

Members or beneficiaries who canceled their OHI but who did not notify TFL of such cancellation also may have their claims denied as discussed in the previous paragraph.

Status: TFL can’t correct the problem unless they are made aware of the cancellation.

Beneficiary Action Needed:If notified that your TFL claim was denied for this reason, call the TFL call center toll-free at 1-888-363-5433. The call center can provide a phone number for your state/region that you can call to update your TFL records to show your OHI has been canceled. Your claim then can be reprocessed automatically.

The single most frequent reason for a denied claim (almost half of all denials) is that something in the Medicare or TFL files shows the beneficiary has other health insurance (OHI). Despite intensive efforts by TMA, MOAA and many others, only 63% of TFL-eligibles have told DoD of their intent to retain or drop any Medigap insurance coverage they may have had.

If you previously used other insurance, your claims history with Medicare or TRICARE usually will still reflect that you have OHI unless you report its cancellation date. And if the TRICARE system understands you still have Medicare supplemental insurance coverage, your claim will be denied.

Another problem may occur if you have decided to keep your OHI and don’t tell DoD.
In some cases, this can cause TRICARE to make a duplicate payment to your doctor (i.e., in addition to the payment from your other policy) that later may have to be recouped. This results in administrative problems for DoD, for your doctor, and for you. These administrative problems could result in TFL getting a bad name with providers and that could hurt all military beneficiaries.

The success of the program depends on TFL beneficiaries doing their part to make sure that the claims processors have accurate information about their coverage. So it is important for you if you are a Medicare-eligible member or beneficiary to confirm to DoD whether you have OHI and, if so, whether you plan to cancel or retain it, and the effective date of any planned cancellation.

You should call DoD today and furnish this important information toll free at 888-363-5433.

Contacting DoD has no effect on your current Medicare supplement. If you wish to make any changes to your existing supplemental coverage, you will still have to contact your insurance carrier to make those arrangements.
You are under no obligation to cancel your Medicare supplement, but you do NEED to communicate your intentions to DoD to guard against having a claims problem.

If you need additional TFL information visit by clicking TRICARE Web Site
..Click On the BLUE Menu On Your Left "Tricare Programs......Choose Tricare for Life
or call toll free 888-DOD-LIFE (888-363-5433) for assistance with resolution of any claims problems.
You may also contact your local directory assistance operator by calling the nearest military hospital/clinic or get TRICARE Service Center related information online at Site Address

Click on site address

============== SOURCE: TRICARE web site at http://www.tricare.mil

Click on site address