Using TRICARE benefits with other health insurance

  • Published
  • By Brian Smith
  • TriWest Healthcare Alliance
TRIWEST --  For family members covered by both a TRICARE plan and other health insurance, knowing how to use the two together will help ensure that claims are processed quickly and correctly.

TRICARE, in most cases, will pay second to the OHI. However, TRICARE is the primary payer for beneficiaries entitled to a public program like Medicaid, the Indian Health Service or those with TRICARE supplementary coverage. TRICARE beneficiaries with OHI who are unsure of how the two plans relate should visit the TRICARE Web site www.tricare.mil/OHI or contact TriWest Healthcare Alliance, TRICARE's West Region contractor, at 1-888-TRIWEST (874-9378).

Don't forget the form

Beneficiaries with OHI must complete the TRICARE Other Health Insurance Form and submit it to TriWest. This form can be found online at www.triwest.com or requested at 1-888-TRIWEST (874-9378). The OHI form can also be used to note any changes, additions or cancellations to existing OHI coverage. If the beneficiary's OHI information is not up-to-date, TRICARE may delay or deny claims.

Users registered at www.triwest.com can log in to monitor and update OHI information. Visitors can register by clicking the "Register As A New User" button on the left side of the page. Registered beneficiaries logged into the secure Beneficiary portal will find a link to their OHI information under the "Update" heading.

When TRICARE is the secondary payer, medical bills for all health care services--except for services provided by a military treatment facility--must be submitted to the OHI company first. Once the OHI pays the claim, the beneficiary or the provider must submit a TRICARE claim to TriWest with the Explanation of Benefits from the OHI showing what that company paid. TRICARE does not guarantee payment of the entire remaining bill and will not pay more than the TRICARE allowable charge. TRICARE may cover services when they are not covered by OHI, provided the beneficiary follows all of TRICARE's rules, including getting the necessary pre-authorizations and referrals.

Know the rules

TRICARE may not cover claims denied by the OHI when the beneficiary does not follow the OHI company's rules. If the entire bill is not paid by OHI, the beneficiary or provider may submit a claim with a copy of the OHI's Explanation of Benefits to WPS, West Region Claims, P.O. Box 77028, Madison, WI 53707-1028.

If TRICARE determines a payment was made to a beneficiary for an incorrectly submitted OHI claim, TRICARE will seek to recover the payment from the beneficiary. Following the rules for both the OHI coverage and TRICARE coverage will help avoid difficulties when submitting claims.

For help coordinating OHI and TRICARE, visit TriWest at www.triwest.com or call 1-888-TRIWEST (874-9378) for more information.