Tricare Claims Update and Instructions Jan 2022

The first thing you will need to do is search for Claims using the criteria below, and then you can Reprocess Claims according to their Status:

• Process NEW Tricare "Clean Claims"
• Reprocess Fully Denied Claims
• Reprocess Partially Paid Claims

Related Article: Helpful Links Provided by TriCare

Searching Claims for Reprocessing

Using the Submission Report, filter Claims using:

1. Contract - Tricare
2. Leave the Default Settings for:
   • Ready to Bill – All
   • Billing Status – None selected
   • Group By – Day 
   • Filter By – Performed Date
3. Search Date Range to include 8/1/2021 to 12/22/2021.
   

   NOTE: We recommend setting the Date range for 2 week or 1 month increments to decrease the Report processing time. For example, search 8/1/2021 - 8/31/2021 and then repeat the search for 9/1/2021 - 9/30/2021, etc. 

4. Check box for Display Billed Date.
   

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Process New Tricare Claims “Clean Claims”

• Any Claims that have not been billed to Tricare through the Clearinghouse or the Tricare Portal can be marked as Ready to Bill and billed out as normal.
• Any claims that were billed out after 12/22/2021 should not have any issue with processing and will likely still be in process with the payor.

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Reprocess Fully Denied Claims

Claims that have been fully denied with no payment applied should show in Error status in the Submission Report, but they may show in Billed status as well.

1. Click on the Title in the Submission Report.
2. Remove the TCN.
3. Uncheck Errors Outstanding.
   
   
   
4. Mark Claims as either Hour Change Next Bill or Pending.
   

   IMPORTANT: Either Status will complete the rebilling process. We recommend Hour Change Next Bill to signify that there has been a change to the billing item when looking through version history for future reference.

5. Lastly, mark as Ready to Bill, and the claims will go out with the nightly batch.

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Reprocess Partially Paid Claims

Claims that have had any payment applied, but not fully paid should show in Partially Paid status, but they may show in Billed status as well.

1. Click on the Title in the Submission Report.
2. Copy Error TCN and paste into TCN field (you may leave the TCN in both fields for reference).
   
   
   
3. Mark Claims Hour Change Next Bill to signify a corrected Claim.
   

   NOTE: Marking them as Pending will still send the claim out as a corrected claim, but it may not give you clarity in version history for future reference.

4. Lastly, mark as Ready to Bill, and Claims will bill out with the nightly batch.

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