Eligibility
What plans are an ADSM eligible for?
Prime and Prime Remote
A QLE
What is the payer ID?
99726
What three pieces of information do we get from a bene when verifying?
Name, Dob and DBN(or Sponsor SSN, DOD ID)
What do we need to verify a provider?
Caller name, Tax ID or NPI and name of facility
What does USFHP stand for?
US family health plan
Does ADFM have enrollment Fees?
NO
What is the claims address for reconsiderations?
Tricare West Correspondence
Po Box 2748
Virginia Beach VA 23450
Is there a limit to how many family members can be under a benes plan?
No there is not
What is the portal called for providers?
Availity
Can a pregnant GF enroll into Tricare?
No
What is the time frame a QLE must be used in?
90 Days
Blank is a secure, full service online claims submission tool
XPress Claim
Daughter is born in 01/04/2006, can mom change her pcm?
no over 18
Who do providers talk to with credentialing questions?
Provider services
Can Dependent parent in laws be eligible for tricare?
Yes PLUS
What system is needed for an enrollment to be completed?
Opsconnect
Where do you fax the certificate of medical necessity?
877-989-0030
What is the form called to let sponsor call for spouse?
Authorization to disclose
What is the fax number to send the provider NN Birthing center application?
877-989-0066
What is it called when a service member is coming off orders and no longer at his duty station, but still considered active duty?
What are the requirements for an adsm to be on TPR?
they must live and work more than 50 miles from an mtf
What is ERA?
Electronica Remittance Advice
What plan are retired national guard members on under the age of 60?
TRR