What QLE is it?
Which claim form should it be?
What is the capital?
In what country is the capital located?
Which system/department do we use or transfer call to?
100

Divorce or annulment

Birth of a child

Adoption of a child

Placement of a child by a court in a members home

Children becoming adults (turning 21 yrs)

Death in family


Change in Family Composition

100

Used by hospitals or institutional providers primarily in CONUS and US territories

UB-04

100

Burkina Faso

 Ouagadougou

100

Manama

Bahrain

100
To leave call back note for LEIDOS?
FOCUS
200

Child moving away to college

Relocation to a new country, city, region, or ZIP code

Moving (change of address)

200

Used by individual doctors or non-institutional providers primarily in CONUS and US territories

CMS 1500

200

Slovenia

 Ljubljana

200

 Freetown

Sierra Leone
200

Member wants to enroll to PRIME ADFM?

LEIDOS

300

Gaining or losing permission to have family members accompany the military member, with full military benefits, during an assignment overseas

Change in command sponsorship

(overseas only)

300

Created by International SOS and used by providers overseas

CDW (Claims Development Worksheet)

300

Australia

Canberra

300

Luanda

Angola

300

Mbr. wants to verify why claim was denied?

WPS

400

Turning age 60 (Retired Reserve)

Turning age 65 (becoming eligible for Medicare)

Losing sponsor or family member eligibility

400

Must be included with any beneficiary claim for reimbursement of out-of-pocket charges

DD2642

400

Finland

Helsinski

400

Berlin

Germany

400

Mbr. needs to verify if newborn's fever is serious?

TRICARE Operations medical team

500

Losing or gaining other health insurance

Losing or gaining other health insurance

500


How are claims processed?

Claims are processed by the order in which they are received

500
Mozambique

Maputo

500
Victoria

Seychelles

500
Mbr. needs to enroll to TRICARE Select? Which system will you use?

DOES