TRICARE Dual-Eligibility Fiscal Intermediary Contract

1. TRICARE Dual-Eligibility Fiscal Intermediary Contract TRICARE Management Activity

2. TRICARE Dual-Eligible Fiscal Intermediary Contract Provides a single point for claims processing, and customer and administrative services for individuals who are eligible for both TRICARE and Medicare Awarded July 25, 2003, to Wisconsin Physicians Service Insurance Corporation (WPS), of Madison, Wisconsin Implementation with new regional contracts Logo: WPS TRICARE For Life Dr. William Winkenwerder Jr., Assistant Secretary of Defense for Health Affairs, announced on July 25, 2003, the awarding of the TRICARE Dual-Eligible Fiscal Intermediary Contract (TDEFIC) The purpose of the contract is to provide a separate medium for claims processing, customer service and administrative services for individuals who are eligible for both TRICARE and Medicare. The TDEFIC will replace the current practice of the managed care support contractors providing these services. The TDEFIC claims processing, customer service and administrative services will be phased in by region beginning on April 1, 2004. The contract was awarded to Wisconsin Physicians Service Insurance Corporation (WPS), of Madison, Wisconsin. TFL and dual-eligible claims processing is implemented with the start-up of the new regions. The claims division for this population, to include those TRICARE-Medicare dual-eligible under age 65, is referred to WPS TRICARE For Life. Dr. William Winkenwerder Jr., Assistant Secretary of Defense for Health Affairs, announced on July 25, 2003, the awarding of the TRICARE Dual-Eligible Fiscal Intermediary Contract (TDEFIC) The purpose of the contract is to provide a separate medium for claims processing, customer service and administrative services for individuals who are eligible for both TRICARE and Medicare. The TDEFIC will replace the current practice of the managed care support contractors providing these services. The TDEFIC claims processing, customer service and administrative services will be phased in by region beginning on April 1, 2004. The contract was awarded to Wisconsin Physicians Service Insurance Corporation (WPS), of Madison, Wisconsin. TFL and dual-eligible claims processing is implemented with the start-up of the new regions. The claims division for this population, to include those TRICARE-Medicare dual-eligible under age 65, is referred to WPS TRICARE For Life.

3. TRICARE Dual-Eligible Fiscal Intermediary Contract Contract Objectives Optimize the delivery of claims payment and customer service Establish and maintain beneficiary and provider satisfaction Use an effective management approach to provide necessary services Incorporate commercial best practices when practical The objectives of the contract are as follows: To optimize the delivery of claims payment and customer service to dual eligible beneficiaries To establish and maintain beneficiary and provider satisfaction at the highest level possible To use an effective management approach to provide necessary services and simplify processes. To incorporate commercial best practices when practicalThe objectives of the contract are as follows: To optimize the delivery of claims payment and customer service to dual eligible beneficiaries To establish and maintain beneficiary and provider satisfaction at the highest level possible To use an effective management approach to provide necessary services and simplify processes. To incorporate commercial best practices when practical

4. TRICARE Dual-Eligible Fiscal Intermediary Contract Who is Affected? TRICARE For Life beneficiaries TRICARE eligible beneficiaries under the age of 65 eligible for Medicare due to a disability or End Stage Renal Disease (ESRD) and have Medicare Part B TRICARE eligible active duty family members who are Medicare-eligible due to a disability or ESRD. Not required to purchase Medicare Part B until sponsor retires Who is Affected? The TRICARE dual-eligible contract, affects approximately 1.7 million beneficiaries eligible for both Medicare and TRICARE. WPS TRICARE For Life will process claims for the following: TRICARE For Life beneficiaries TRICARE beneficiaries under the age of 65 who are Medicare eligible due to a disability or End Stage Renal Disease (ESRD), and who purchased Medicare Part B Active duty TRICARE eligible family members who are also eligible for Medicare due to a disability or ESRD. These family members are not required to purchase Medicare Part B while the sponsor is on active duty. Who is Affected? The TRICARE dual-eligible contract, affects approximately 1.7 million beneficiaries eligible for both Medicare and TRICARE. WPS TRICARE For Life will process claims for the following: TRICARE For Life beneficiaries TRICARE beneficiaries under the age of 65 who are Medicare eligible due to a disability or End Stage Renal Disease (ESRD), and who purchased Medicare Part B Active duty TRICARE eligible family members who are also eligible for Medicare due to a disability or ESRD. These family members are not required to purchase Medicare Part B while the sponsor is on active duty.

5. TRICARE Dual-Eligible Fiscal Intermediary Contract How does this affect our beneficiaries? 1. Crossover claims Claims are automatically forwarded by Medicare to WPS TRICARE For Life Crossover claims require no action on the part of the beneficiary Includes beneficiaries under the age of 65 who are Medicare and TRICARE eligible. How will this affect our beneficiaries? Medicare submits claims directly to TRICARE. The transition to WPS TFL occurs as the regions transition under the next generation of contracts. The notification letter provides information about WPS TRICARE for Life and addresses for various claims functions, as well as the customer service line and Web site. Cross over claims WPS mails letters to all households with one or more dual-eligible individuals approximately 30 days prior to the region transition over to the new regional contractor. Since most TDEFIC cross-over claims are automatically forwarded by the Medicare carrier or Medicare fiscal intermediary to WPS TRICARE For Life, this change in claims processor should be invisible to the beneficiary WPS TRICARE For Life contacted Medicare carriers to inform them about this change. Beneficiaries should not be affected unless they need to submit a paper claim. WPS is doing an initial mailing to beneficiaries, to include mailing letters to all households with one or more dual-eligible beneficiaries, introducing themselves as the new claims processor for the affected family member(s). Providers are also being informed of this change in TFL claims processors. How will this affect our beneficiaries? Medicare submits claims directly to TRICARE. The transition to WPS TFL occurs as the regions transition under the next generation of contracts. The notification letter provides information about WPS TRICARE for Life and addresses for various claims functions, as well as the customer service line and Web site. Cross over claims WPS mails letters to all households with one or more dual-eligible individuals approximately 30 days prior to the region transition over to the new regional contractor. Since most TDEFIC cross-over claims are automatically forwarded by the Medicare carrier or Medicare fiscal intermediary to WPS TRICARE For Life, this change in claims processor should be invisible to the beneficiary WPS TRICARE For Life contacted Medicare carriers to inform them about this change. Beneficiaries should not be affected unless they need to submit a paper claim. WPS is doing an initial mailing to beneficiaries, to include mailing letters to all households with one or more dual-eligible beneficiaries, introducing themselves as the new claims processor for the affected family member(s). Providers are also being informed of this change in TFL claims processors.

6. TRICARE Dual-Eligible Fiscal Intermediary Contract 2. Paper Claims WPS mails letter to all households with one or more dual-eligible individuals Notifies beneficiaries of the change in mailing address for paper claims submission Beneficiaries with other health insurance (OHI) as secondary payer to Medicare need to file paper claims with TRICARE Must submit the claim form along with an itemized bill, copy of Medicare Summary Notice (MSN) and OHI�s Explanation of Benefits (EOB) statement Paper Claims Additionally the letter notifies beneficiaries and providers of the change in mailing addresses for manual paper claims submissions OHI Beneficiaries who maintain other health insurance (OHI) as secondary payer to Medicare need to file paper claims. Beneficiaries must submit their claim form along with an itemized bill from the provider, copy of the Medicare Summary Notice and an explanation of benefits (EOB) statement from his/her OHI Beneficiaries should keep a copy of all paperwork they submit The beneficiary�s physician may prepare the claim, but it is the beneficiaries responsibility to ensure the claim is filed within one year of date of service. Paper Claims Additionally the letter notifies beneficiaries and providers of the change in mailing addresses for manual paper claims submissions OHI Beneficiaries who maintain other health insurance (OHI) as secondary payer to Medicare need to file paper claims. Beneficiaries must submit their claim form along with an itemized bill from the provider, copy of the Medicare Summary Notice and an explanation of benefits (EOB) statement from his/her OHI Beneficiaries should keep a copy of all paperwork they submit The beneficiary�s physician may prepare the claim, but it is the beneficiaries responsibility to ensure the claim is filed within one year of date of service.

7. WPS TRICARE For Life Contact Numbers Claims Submission: WPS TRICARE For Life P.O. Box 7890 Madison, WI 53707-7890 Third Party Liability (TPL): WPS TRICARE For Life Attn: TPL P.O. Box 7897 Madison, WI 53707-7897 Customer Service: WPS TRICARE For Life P.O. Box 7889 Madison, WI 53707-7889 Toll-free Telephone: (866) 773-0404 Toll-free TDD Telephone: (866) 773-0405 On-line: www.tricare4u.com Here are the key phone number for this TRICARE dual-eligible fiscal intermediary contract as provided by WPS TRICARE For Life. Here are the key phone number for this TRICARE dual-eligible fiscal intermediary contract as provided by WPS TRICARE For Life.

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