Military Health System

1.1  For claims processing jurisdiction purposes, TRICARE regional boundaries do not apply under the TRICARE Dual Eligible Fiscal Intermediary Contract (TDEFIC). The TDEFIC contractor shall be responsible for processing all medical claims for services, except retail pharmaceuticals, rendered to TRICARE/Medicare dual eligible individuals within the 50 United States (U.S.) and the District of Columbia, as well as Puerto Rico, Guam, the U.S. Virgin Islands, American Samoa, and the Northern Mariana Islands.

1.2  Medicare claims processing jurisdiction is based on place of service. The TDEFIC contractor shall contract with the Medicare Coordination of Benefits Contractor (COBC) to ensure that Medicare claims for all TRICARE dual eligible beneficiaries receiving care within the respective carrier’s/FI’s state(s) are electronically forwarded to the TDEFIC contractor. The cross-over claims agreement shall include all TRICARE dual-eligible beneficiaries regardless of the beneficiary’s status (Active Duty Dependent, retiree, survivor, etc.).