Posted by Service Officer on 25th January 2012
17 JAN 2012
TRICARE Provider List Philippines: The current TMA and ISOS provided Certified Provider list available at http://www.tricare.mil/tma/pacific/pacificCertifiedProviders.aspx does not offer any mechanism to easily identify added or removed providers nor is there any way to determine when existing previously certified provider’s addresses or cities have changed. This is of concern to beneficiaries who have submitted or will be submitting claims because:
• Providers that have changes made to their addresses or city are of some importance as the changes may trigger disapprovals of previously approved claims for a provider when the receipts may no longer match the new addresses.
• Beneficiaries should be able to easily identify providers that have been decertified without having to check every provider on the list in their provider base every two weeks.
• Beneficiaries should be able to easily find added providers for those that have claims pending certification of a provider.
• There should be a convenient way for beneficiaries to determine new additions to the provider base in their area without having to review each and every provider in the entire list every two weeks.
Because of these concerns and to assist TRICARE beneficiaries residing in the Philippines the U.S. Military Retirees of the Philippines have produced a supplemental list to the 17 January 2012 Certified Provider List. The supplement is in 5 sections:
• Providers Added Since 1 January 2011
• Providers Removed Since 1 January 2011
• Providers with Changed Addresses Since 1 January 2011
• Providers with Changed Cities Since 1 January 2011
This listing will be updated with each TMA/ISOS update of the certified provider list and the updates can be accessed at http://db.tt/3fROsC4T or viewed by opening the attachment to this message. When the names or addresses of your providers do not match the “official” list, WPS must send ISOS a request to conduct a “new provider” certification, which has and will slow the reimbursement of the claim. It is recommended that beneficiaries verify the name, (spelling), and how it is listed on the certified provider list. Some examples of variance of the official receipts verses the certified provider list that have caused delays in the past are;
• Santos,John R., MD instead of Santos, John R., MD, (the missing space after the comma has caused the claims processor to request a new certification);
• Santos, John Reyes, MD instead of Santos, John R., MD, which will also cause the claims processor to request a new certification.
The same problem will occur with addresses that are not identical on the “official receipt” as to that of the official certified provider list. Beneficiaries are encouraged to check the newest certified provider list for any provider that they have or are going to use and ensure that the official receipt name and address is identical to the certified provider list. If they find that it is not identical they should request the provider to give them a receipt that is identical. If that is not possible, then it is suggested they annotate the variances on the copy of the receipt sent with the claim and explain that this is the same provider as listed on the certified provider list. [Source: U.S. Military Retirees of the Philippines notice 23 Jan 2012 ++]