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Timely Overseas Claims Filing

The United States Government has extended the timely filing requirement for TRICARE Overseas Program (TOP) claims. This applies ONLY to services performed outside the United States and U.S. territories (American Samoa, Guam, the Northern Mariana Islands, Puerto Rico, and the U.S. Virgin Islands), allowing claims to be filed up to 3 years from the date of service or 3 years from the date of discharge for an inpatient admission for facility charges billed by the facility. Professional service billed by the facility must be submitted within 3 years from the date the services were provided.

As a result of this change, overseas claims with a date of service on or after December 31, 2008, which were previously denied for lack of timely filing and were submitted to the TOP claims processor within 3 years of the date of service, will be reprocessed.

If you are receiving payment for a TOP claim number with the last 7 digits between #2980000-#2989999, this means that one of your claims previously denied for timely filing has been successfully reprocessed and qualified for payment.

Note: The timely filing extension applies ONLY to services performed outside the United States and U.S. territories (American Samoa, Guam, the Northern Mariana Islands, Puerto Rico, and the U.S. Virgin Islands). Not all reprocessed claims will result in payment and processing time may vary.

International SOS still encourages providers to submit their TOP Claims and invoices within 1 year of the date of service, to ensure accurate and timely processing.

If you receive payment for any TOP Claims that have been re-processed, please be sure to read your Explanation of Benefits, which will provide the claim details.

As a general reminder, for any TOP claims that fall within the qualifying 3-year timely filing period but have not been previously submitted to International SOS, please be sure to submit these claims using one of the following compliant claim forms: Below are useful Frequently Asked Questions/Answers regarding the 3-year timely filing of TOP Claims.

FAQs (Frequently Asked Questions)

1. What if the TOP beneficiary had other health insurance (OHI) at the time of the date of service, but no longer has OHI?
 
2. What if the TOP claim is for medical services that fall within the 3-year timely filing period, but were not considered a TRICARE covered service at the time of health care delivery?
 
3. How can Providers verify beneficiary eligibility if the overseas claim is for covered medical services that were delivered more than 1 year ago or if the beneficiary is no longer deployed overseas? What if the Provider is unable to verify eligibility in DEERS or the secure claims portal?
 
4. International SOS began administering health care delivery services under the TRICARE Overseas Program (TOP) contract in September 2010. What if the overseas claim is for covered medical services that were delivered before the TOP contract began?
 
5. What if Providers are unsure about an overseas claim and whether or not it will be processed under the 3-year timely filing deadline extension?
 
6. I am a TOP Provider and I still have questions regarding the 3-year timely filing extension. What should I do?

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