TRICARE Overseas Program (TOP)
Chapter 24
Section 30
Figures
Revision:
Figure 24.30-1 Overseas
Pharmacy Provider Notice Letter (Sample)
|
(Provider
Name)
(Provider
Street Address)
(Provider
City, State and Zip Code)
|
|
|
|
Dear (Provider
Name):
|
|
|
|
The Department
of Defense, through Defense Health Agency (DHA), is responsible
for appropriate cost containment for services provided to TRICARE
beneficiaries. One particular area of concern has been the costs
billed for prescription drugs. In an effort to establish a Uniformed
Military Services drug benefit and claim processing requirement
for all TRICARE eligibles, the Deputy Director, DHA, has determined
that pharmacy claims submitted for services outside the United States
(U.S.) must be reimbursed in accordance with the reimbursement formulas
for TRICARE U.S. claims as established under the Code of Federal
Regulations (CFR).
|
|
|
|
This letter notifies
you that effective 60 days from date on this letter, (Date),
overseas pharmacy claims submitted will be processed in accordance
with the reimbursement formulas for TRICARE claims in the U.S. which
are from a schedule of allowable charges based on the Average Wholesale
Price (AWP) rates plus $3.00 administration fee. Should you have
any questions regarding this requirement, please write me at (Contractor
Mailing Address).
|
|
|
|
Sincerely,
|
|
|
|
|
|
|
|
(Contractor
Name)
|
|
|
|
(Contractor
Title)
|
Figure 24.30-2 TRICARE Overseas Program (TOP)
Contractor Provider Certification Request Letter
|
OVERSEAS
|
|
|
|
(Sample
Philippine Contractor Provider Certification Request Letter)
|
|
|
|
Dear Provider:
|
|
|
|
(TOP Contractor
Name), your TRICARE claims processor has received a claim
for services provided by you.
|
|
|
|
You are not currently
listed with us as a TRICARE authorized/credentialed provider. To
complete processing of your claim, you must request to be an authorized/credentialed
TRICARE provider. So that we may complete the processing of your
claim, please complete the attached
TRICARE
Provider Application including copies of your current license(s).
Unless we receive the requested license(s)/credentials the claim
will be denied.
|
|
|
|
Please return
the completed application with copies of your license(s)/credentials
to:
|
|
|
|
(Contractor’s
Name and Address)
|
|
|
|
|
|
|
|
Sincerely,
|
|
|
|
|
|
|
|
(Contractor’s
Name)
|
- END -