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
Used by hospitals or institutional providers primarily in CONUS and US territories
UB-04
Burkina Faso
Ouagadougou
Manama
Bahrain
Child moving away to college
Relocation to a new country, city, region, or ZIP code
Moving (change of address)
Used by individual doctors or non-institutional providers primarily in CONUS and US territories
CMS 1500
Slovenia
Ljubljana
Freetown
Member wants to enroll to PRIME ADFM?
LEIDOS
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)
Created by International SOS and used by providers overseas
CDW (Claims Development Worksheet)
Australia
Canberra
Luanda
Angola
Mbr. wants to verify why claim was denied?
WPS
Turning age 60 (Retired Reserve)
Turning age 65 (becoming eligible for Medicare)
Losing sponsor or family member eligibility
Must be included with any beneficiary claim for reimbursement of out-of-pocket charges
DD2642
Finland
Helsinski
Berlin
Germany
Mbr. needs to verify if newborn's fever is serious?
TRICARE Operations medical team
Losing or gaining other health insurance
Losing or gaining other health insurance
How are claims processed?
Claims are processed by the order in which they are received
Maputo
Seychelles
DOES