To be successful in submitting Tricare claims in NPAWorks, an RBT must be registered with Tricare. Tricare requires the Service Provider ID to be included on claims for selected services. This document will show the User how to set up a Service Provider ID and how that ID is used when generating claims.  

Adding a Service Provider ID

1. Open a staff record. On the General tab, click on the Special Identifier button.
   
   
    
2. On the Special Identifiers page, click the Add button.
   • If the staff member has a registered NPI, select Type [NPI], enter the NPI in the ID/Number/Code, and check Service Provider. Click OK to close the page.
   • Please note: If the staff also has a special identifier Type of [NPI] and Rendering Provider is selected, the staff will be treated as a rendering provider for Tricare claims and the Service Provider rules will be ignored.
     
     
     
      
   • Tricare has announced that all providers are required to have an NPI. If the organization is still using social security numbers as service provider ID, please add the Staff NPI as shown above.

Tricare Service Provider Claim Requirements As Of August 2021

1. If the service is Direct Intervention and the staff member for the appointment does not have a Rendering Provider NPI, the provider in this case is called the Service Provider.
2. The Service Provider’s ID is an NPI. The NPI is displayed in the white section of Box 24j with no qualifier.
   
   
   
   
    
3. A separate claim must be created for each Service Provider/Place of Service. This means when billing for multiple services that occurred on the same day by the same rendering provider but at different places of service, each session must be on a separate claim line, even if the CPT is the same. This process is accomplished during the Claims Wizard process:

Generating Claims in Claims Wizard: Tricare Claims

Claims Wizard will display Service Provider IDs when claims are generated for Funding Sources that have Tricare in the funding source name. The Service Provider ID is displayed in Steps 1, 2, and 3 of the Claims Wizard to the right of the Rendering Provider. Information that is required for every claim is grouped together so it is visible without having to scroll to the right in the screen (Place of Service, Rendering Provider, etc.).

Step 1 of the Claims Wizard



Step 2 of the Claims Wizard
In order to group Tricare claims correctly, all parameters in the Appointment to Claim Line Item Grouping must be unchecked with the exception of Contracts:



Once the parameters have been unchecked, click the Regroup button on the right side.

Step 3 of the Claims Wizard
Click on Prepare Claims

The resulting claim shows each service date, POS, CPT, and Modifier on a separate line.
 

Once the Tricare claim file has been created, go back to Claims Wizard and run for all Funding Sources. Be sure to re-check all parameters in the Appointment to Claim Line Item Grouping and then click Search in Step 2 of the Claims Wizard.

• For Tricare claims only, when the 837p file is exported or sent to the clearinghouse, the session times will be added to the claim. If there are multiple appointments for the same Provider, Place of Service, and CPT on the same day, the start and end times of each CPT are included in the 837p file on separate service lines.
• In a future release, session times will also display on the CMS 1500 form in the shaded area above the Charge Line in Box 24a. Until that release happens, for all CMS 1500 forms to be printed, session times will have to be manually entered in Review/Edit Claim: