Claims
As with other commercial health plans, TRICARE Prime® Demo by CareSource Military & Veterans™ (CSMV) beneficiaries are responsible for any applicable copays or cost shares. Providers are responsible for collecting the appropriate payments. Please note that the provider cannot bill a beneficiary for activities that improve health care quality.
Note: Please refer to the Provider Manual for in-depth information regarding claims procedures, payment processing, claims status, and more.
Preferred Option: Submit Claims Online
Providers have the option to submit claims through our secure Provider Portal. You can submit claims and any necessary attachments, track claim payments, and more. CSMV offers this service at no cost.
Submit Claims Online Using the Provider Portal
We encourage you to submit claims online to take advantage of the following benefits:
- Faster claim processing
- Reduced administrative costs
- Reduced probability of errors or missing information
- Faster feedback on claim status
- Minimal staff training or cost
What Types of Claims Can Be Submitted?
- Professional medical office claims (CMS 1500 and 837P)
- Institutional claims for Inpatient and Outpatient Services Inpatient and Outpatient Services (UB-04 and 837I)
Note: For more information on the TRICARE Dental Program, please refer to www.tricare.mil/ CoveredServices/Dental.
Atypical Providers
When an atypical provider submits claims, TRICARE Prime Demo requires a National Provider Identifier (NPI) from providers. If a provider submitting a claim does not have an NPI, then they should submit the NPI of the billing and supervising provider.
Billing Provider * Required Data / In the Rendering Provider field will be the Supervising Providers below information: *Required Data -NPI -TAX ID
Get Paid Electronically
We partner with ECHO Health, Inc. to deliver provider payments. ECHO offers three payment options:
- Electronic fund transfer (EFT) – preferred
- Virtual Card Payment (QuicRemit) – standard bank and card issuer fees apply*
- Paper Checks
*Payment processing fees are what you pay your bank and credit card processor for use of payment via credit card.
Enrollment Instructions
Enroll with ECHO for payment and choose EFT as your payment preference for CareSource.
Questions? Call ECHO Customer Support at 1-888-834-3511.
Electronic Claim Submission
Electronic Data Interchange (EDI) is the computer-to-computer exchange of business data in ANSI ASC X12 standard formats. EDI transmissions must follow the transaction and code set format specifications required by the Health Insurance Portability and Accountability Act (HIPAA). CSMV has invested in an EDI system to enhance our service to network providers. Our EDI system complies with HIPAA standards for electronic claims submission.
Clearinghouse
CSMV prefers electronic claim submission. To submit claims electronically, providers must work with an electronic claims clearinghouse. We currently accept electronic claims from providers through the clearinghouse listed below. Contact the clearinghouse to begin electronic claims submission.
| Clearinghouse | Phone | Website |
|---|---|---|
| Availity | 1-800-282-4548 | www.availity.com/ |
Please provide the clearinghouse with the TRICARE Prime Demo payer ID MVCS1.
Alternative Option: Paper Claims
Paper claim forms are encouraged only for services that require clinical documentation or other forms to process. Refer to the Provider Manual for instructions to submit paper claims.
Providers can upload paper claims via the Provider Portal. You can also mail or fax paper claims to the following address:
TRICARE Prime Demo
Attn: Claims Department
P.O. Box3607
Dayton, OH 45401-8730
Fax: 937-224-3388
Non-Participating Providers
Non-participating providers may submit claims to CSMV using the Non-Participating Provider Profile Form. We are unable to process claims without this information. Please be sure to attach your W-9 form when you submit this online form.