TFL Denied Claims [DEERS]: Payment for some health care claims were
initially denied by TRICARE for individuals recorded as being ineligible
for TRICARE in the Defense Enrollment Eligibility Records System (DEERS).
In many cases, these denials were based on persons who have "expired
eligibility" in DEERS, meaning that their eligibility has not been
re-verified in the last four years as required by DoD policy. DoD
announced 5 FEB 02 that TRICARE claims will be paid for a limited time for
TRICARE For Life (TFL) beneficiaries with "expired eligibility" in DEERS.
Claims filed beginning October 1, 2001 but denied due to "expired
eligibility" will be automatically reprocessed. Neither beneficiaries nor
providers will be required to resubmit the denied claims. Beneficiaries are
required, however, to ensure their eligibility is updated in DEERS by
August 1, 2002. To learn how to update or re-verify eligibility for those
persons 65 and older, beneficiaries who have received an Explanation of
Benefits (EOB) stating that they need to get a new military ID card should
call 1-800-361-2620. For more information on TRICARE for Life, interested
persons can visit the TRICARE Web site at www.tricare.osd.mil, or call the
TRICARE Information Center, toll-free, at (877) 363-5433. [Source: TRICARE
News Release at www.tricare.osd.mil.
If a TFL spouse dies and the ID card had expired prior to her death
TFL will pay the allowable expenses
expenses for the period from the date her card expired till
death. However, because the eligibility is seen in DEERS as indicating
"Ineligible", any claims received at the TRICARE FI would be denied until
the eligibility is reestablished. The important thing is to have the
deceased spouse's eligibility updated as soon as possible. To do so the
sponsor (if still living) or someone else needs to go to an ID Issuing
Facility and bring the DD214, Marriage Certificate, Death Certificate, and
a Photo ID (Drivers License, etc.). Original documents are preferred but
Certified Copies will be acceptable. Once the DEERS system is updated it
will indicate that the individual was eligible from expiration of
eligibility to date of death. There may be some difficulty with the
processing of the claims at first, but TFL will kick in after Medicare
processes claims. Any denied claims by TRICARE will need to be resubmitted
to TRICARE; if eligibility is established, then claims will be paid.
[Source: B Gen Bob Clements USAF ret p38bob@deepwell.com ]