CarrieL_60331
New member
I'm looking for help with Tricare billing and the 15% up-charge for non-network providers.
Thanks
Thanks
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I'm looking for help with Tricare billing and the 15% up-charge for non-network providers.
Thanks
I have worked for 18 years billing/collecting and based on my experience most health insurance companies do not cover infertility and some other cover infertility related diagnostic testing but not procedures. They do base it on the diagnosis. Knowing the member's/patient's benefits is essential since sometimes even when the service is covered you will still need authorization or to have an LOA on file specially if the services were rendered by a non-par provider.
Hope this helps
Being a Non-Par Tricare Provider we don't check coverage. We do abide by the balance bill amount of 115% of the Tricare allowable. Being that some of our procedures/visits are GYN based, fertility testing and/or infertility treatment I get myself confused sometimes. I know to apply the 115% to the GYN visits and anything infertility related is charged our "cash" price since it's not a Tricare covered service. The fertility testing (Z31.41) is where I'm second guessing if it's a "covered service" or not .... so I know know how to bill the patients.
Fertility treatments (I believe) are a covered benefit with Tricare, however at MTFs (Medical treatment facilities). As a non-participating provider, a non-covered benefit would be the patient's responsibility. Unless you are able to obtain the dollar amount prior to the visit (through a web verification system with the codes) waiting for the RA/EOB/EOR would be the best option to know the amount the patient is responsible for.