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TRICARE Operations Manual 6010.62-M, April 2021
Claims Processing Procedures
Chapter 8
Section 4
Signature Requirements
1.1  The contractor shall comply with state laws and with corporate policy for requiring signatures on their private business claims in establishing signature requirements for financially underwritten TRICARE claims.
1.2  However, when the private or state signature requirements conflict with Federal Privacy Act, Health Insurance Portability and Accountability Act (HIPAA), or Freedom of Information Act (FOIA) requirements, the latter shall prevail.
1.3  The contractor shall comply with the following requirements in processing non-network TRICARE claims for which the signature of the beneficiary, spouse, or parent or guardian of a beneficiary is required unless qualifying for an exception.
1.4  The contractor shall return the claim to the beneficiary for his or her signature, unless the beneficiary is not competent, if additional personal information or release of medical information is required to complete claim processing.
3.1  Non-Participating Provider Claims
3.1.1  The claim should be signed by the parent or legal guardian if the beneficiary is under 18 years of age.  However, if the beneficiary signs the claim form legibly, the claim should be processed unless there is other reason to return the claim form, or doing so conflicts with state law or contractor policy.  The contractor shall request the parent or legal guardian signature if the claim form is returned except for the two exceptions listed below. In the following situations, a beneficiary under 18 years of age may always sign the claim form in his or her own behalf in accordance with state laws related to the age of consent and the Federal Privacy Act.
3.1.2  Exceptions
•  He or she is (or was) a spouse of a Service Member; or
•  He or she is a Service Member; or
•  The services are related to venereal disease, substance or alcohol abuse, reproductive health, or abortion.
3.1.3  Participating Provider Claims
If a claim is signed by a beneficiary who is under 18 years of age but the provider agrees to participate, it is not necessary to obtain the signature of the parent or legal guardian.
4.1  When the beneficiary is mentally incompetent or physically incapable, the person signing should be either the legal guardian, or in the absence of a legal guardian, a spouse or parent of the patient. The person signing should:
•  Write the beneficiary’s name in the appropriate space on the claim form, followed with the word “by” and his or her own signature;
•  Include a statement that a legal guardian has not been appointed, if such is the case;
•  Include documentation of appointment if a legal guardian has been appointed or if a power of attorney has been issued. Attach a statement giving his or her full name and address, relationship to the patient, and the reason the patient is unable to sign. Beneficiaries who have no legal guardian or family member available to sign claims, can provide documentation (i.e., a report from a physician describing the physical and or mental incapacitating illness). For those conditions or illnesses which are temporary, the signature waiver needs to specify the inclusive dates of the condition or illness.
4.2  A beneficiary who is physically incapable of signing their signature can have a general or limited power of attorney issued by having their “mark” (e.g., an “X”) witnessed and notarized.
5.1  The contractor shall process a claim if the provider of care has an approved signature on file agreement and the beneficiary expires, the authorization for payment will satisfy the signature requirements.
5.2  If the beneficiary is deceased, the claim form must be signed by the legal representative of the estate.
5.2.1  Documentation must accompany the claim form to show that the person signing is the legally appointed representative.
5.2.2  If no legal representative has been appointed, the claim form may be signed by the parent, the spouse, or the next of kin. The signer must provide a statement that no legal representative has been appointed. The statement should contain the date of the beneficiary’s death and the signer’s relationship to the beneficiary to enable the contractor to update the history file.
5.3  The contractor shall arrange to pay the provider whether network or non-network for services rendered in accordance with state law and corporate policy, when there is no legal representation.
6.1  Use of the signature on file procedure is the provider’s indication that he or she agrees that verification of the beneficiary’s TRICARE eligibility at the time of admission or at the time care or services are provided is required prior to any TRICARE payment.
6.2  The below, or comparable language acceptable to TRICARE, shall be incorporated into the provider’s permanent records.
6.2.1  Institutional Providers
“I request payment of authorized benefits to me or on my behalf for any services furnished me by (Name of Provider), including physician services. I authorize any holder of medical or other information about me to release to (Contractor’s Name) any information needed to determine these benefits or benefits for related services.” Professional providers who submit claims on the basis of an institution’s signature on file should include the name of the institutional provider that maintains the signature on file. The Centers for Medicaid and Medicare Services (CMS) 1450 UB-04 instructions shall be followed for certifying signature on file except that the permanent hospital record containing a release statement will be recognized. “Institutional” includes all claims related to an institution.”
6.2.2  Professional Providers
“I request that payment of authorized benefits be made either to me or on my behalf to Dr. ______, for any services furnished me by that physician. I authorize any holder of medical information about me to release to (Contractor’s Name) any information needed to determine these benefits or the benefits payable for related services.”
6.3  If a claim is submitted by a nonparticipating provider and payment will not be made to the patient, the provider must indicate the name, address, and relationship of the person to whom payment will be made. This will be the sponsor, other parent or a legal guardian for minor children or incompetent beneficiaries, except for claims involving abortion, venereal disease or substance/alcohol abuse.
6.4  The provider shall cooperate with the contractor’s post-payment audits by supplying copies of the requested signature(s) on file within 21 calendar days of the date of the request and/or allow the contractor access to the signature files for purposes of verification. See Chapter 1, Section 4, and Chapter 11, Section 5 for audit requirements.
6.5  The provider shall correct any deficiencies found by the contractor’s audit within 60 calendar days of notification of the deficiency or participation in the signature relaxation program will be terminated.
6.6  Institutional Claims
6.6.1  The provider must obtain the beneficiary or other authorized signature on a permanent hospital admission record for each separate inpatient admission.
6.6.2  A professional provider submitting a claim related to an inpatient admission must indicate the name of the facility maintaining the signature on file.
6.6.3  Claim forms must indicate that the signature is on file.
6.7  Professional Provider Claims
6.7.1  Outpatient professional providers such as physician’s office and suppliers such as Durable Equipment (DE) and Durable Medical Equipment (DME).
6.7.2  Authorized individual providers have the option to retain on their own forms appropriate beneficiary release of information statements for each visit or obtain and retain in the provider’s files a one-time payment authorization applicable to any current and future treatment that the authorized individual provider may furnish the beneficiary.
6.7.3  Claim forms shall indicate that the signature is on file.
Note:  On the claim form for Telemedicine services, originating telemedicine site provider may indicate “Signature not required - Distant Telemedicine Site” in the required Patient Signature field.
6.8  Outpatient Ancillary Claims
6.8.1  Outpatient ancillary claims are claims that are submitted from an independent laboratory where, ordinarily, no patient contact occurs.
6.8.2  A provider submitting a claim for diagnostic tests or test interpretations, or other similar services, shall not be required to obtain the patient’s signature. These providers shall indicate on the claim form: “patient not present.”
6.8.3  For services when there is patient contact, such as services furnished in a medical facility which is visited by the beneficiary, the same procedure used for professional claims for outpatient services shall be required, except that the provider shall indicate along with “signature on file” information, the name of the supplier or other entity maintaining the signature on file.
6.9  Verification Of Provider’s Compliance With The Beneficiary Signature On File Requirement
The contractor shall verify beneficiary signature on file compliance using the post-payment audit requirement in paragraph 6.2.2, and Chapter 1, Section 4, and the audit procedures in Chapter 11, Section 5.
7.1  A provider or an employee of an institution providing care to the patient may not sign the claim form on behalf of the beneficiary under any circumstances.
7.2  Nor can an employee of a contractor execute a claim on behalf of a beneficiary (unless such employee is the beneficiary’s parent, legal guardian, or spouse).
7.3  Beneficiaries, who have no legal guardian or family member available to sign claims can provide documentation (i.e., a report from a physician describing the physical and/or mental incapacitating illness).
7.4  For those conditions or illnesses which are temporary, the signature waiver needs to specify the inclusive dates of the condition/illness.
7.5  If the beneficiary is unable to sign due to an incapacitating condition or illness, the provider can annotate in the Signature Box on the TRICARE claim form “Unable to sign.” A letter from the provider shall be attached to the claim form describing the physical and/or mental incapacitating illness. For those illnesses, which are temporary, the letter needs to specify the inclusive dates of the illness.
8.1  Administrative Tolerance - Certain Ancillary Services
8.1.1  The contractor shall, for claims for inpatient anesthesia, laboratory and other diagnostic services in the amount of $50.00 or less provided by physician specialists in anesthesiology, radiology, pathology, neurology and cardiology not return for beneficiary signature unless required by state law or contractor corporate policy.
8.1.2  Claims submitted by an institution when the claim is for those specific ancillary services cited above, should be included in this tolerance if the services were performed in an institution other than the institution in which the beneficiary is receiving inpatient care.
8.2  Beneficiary (Sponsor, Guardian, Or Parent Moved) Unable To Locate
8.2.1  The contractor shall waive the requirements for a beneficiary’s (sponsor, guardian, or parent) signature in the following situations for claims received from non-network participating providers.
8.2.2  The contractor shall grant a waiver after the procedures described below have proven unsuccessful.
8.2.3  The contractor shall attempt to obtain the address by telephone, from internal files, or Defense Enrollment Eligibility Reporting System (DEERS).
8.2.4  The contractor shall return the original claim to the beneficiary or sponsor with the request for signature if a new address is obtained.
8.2.5  The contractor shall grant a signature waiver for a participating provider if the signature is not obtained because the new address is still not valid and the patient cannot otherwise be located.
Signature requirements for network providers are dependent upon the provisions of the agreement and administrative procedures established between the providers and the contractor.
10.1  The signature of the non-network provider, or an acceptable facsimile, is required on all participating claims.
10.2  The contractor shall return the claim if a non-network participating claim does not contain an acceptable signature.
10.2.1  The provider’s signature is also required to certify services rendered when a provider completes a nonparticipating claim for the beneficiary.
10.2.2  The contractor may, if the provider does not sign, contact the provider by telephone to verify the delivery of services or return the claim for signature. A claimant may also attach an itemized bill on the letterhead or billhead of the provider verifying delivery of services.
Note:  The provider’s signature block Form Locator (FL) has been eliminated from the CMS 1450 UB-04. As a work around, the National Uniform Billing Committee (NUBC) has designated FL 80, “Remarks”, as the location for the signature, if signature on file requirements do not apply to the claim.
10.3  Facsimile Or Representative Signature Authorization
10.3.1  In lieu of a provider’s actual signature on a TRICARE claim, a facsimile signature or signature of a representative should be accepted if the contractor has on file a notarized authorization from the provider for use of a facsimile signature (Addendum A, Figure 8.A-1) or a notarized authorization or power of attorney for another person to sign on his or her behalf (Addendum A, Figure 8.A-2).
10.3.2  The facsimile signature may be produced by a signature stamp or a block letter stamp, or it may be computer-generated, if the claim form is computer-generated.
10.3.3  The authorized representative may sign using the provider’s name followed by the representative’s initials or using the representative’s own signature followed by Power of Attorney (POA), or similar indication of the type of authorization granted by the provider.
10.4  Verification Of Provider Signature Authorization
10.4.1  The contractor shall assume, in the absence of any indication to the contrary, the proper authorization is on file, validating through file checks, those claims containing facsimile and representatives’ signatures which are included in their quality control audit and program integrity samples.
10.4.2  The contractor shall remind providers of the requirement for current signature authorizations through at least an annual notice in routine bulletins or newsletters and at other appropriate times when contacts are made.
10.4.3  The contractor may return a claim with a request for the signature authorization when it is found that there is no authorization on file or it is out-of-date as follows:
•  Send a request to the provider advising of the need for authorization; and
•  Set a utilization flag on the provider’s file to stop further payment to the provider when the proper signature is not on the claim, pending receipt of the authorization.
•  Advise the provider that if the authorization is not received, it will be necessary to deny the claim or to process it as a nonparticipating claim, depending on the information available to make a payment determination.
•  Schedule a contractor representative visit to resolve any problem which may develop in the unlikely event a provider chooses not to cooperate.
10.5  Certification Of Source Of Care
10.5.1  Source of care certification is used to help determine the correct payee on the participating UB92/UB-04 and the CMS 1500. (The CMS 1450 UB-04 eliminated the provider’s signature block FL from the form. As a work around, the NUBC has designated FL 80, “Remarks”, as the location for the signature, if signature on file requirements do not apply to the claim.)
10.5.2  Submission of the UB-04 claim form by an institution or provider certifies the institution or provider is complying with all the TRICARE certifications on the reverse of the claim.
10.5.3  Provider signature on file requirements apply to the claims if not signed.
10.5.4  The contractor shall, if signed by the provider and the certification is unaltered, issue payment to that provider.
10.5.5  The contractor shall, if signed with alteration of the certification, issue payment to the beneficiary (parent or legal guardian of minor or incompetent).
10.5.6  The contractor shall, if unsigned and an itemized billing on the provider’s letterhead is not attached, return the claim.
Note:  For procedures in case of any irregularities, refer to Chapter 13, Program Integrity.
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