Providers must keep a “signature on file” for TRICARE-eligible beneficiaries to protect patient privacy, release important information and prevent fraud. A new signature is required for each admission for claims submitted on a UB-04 claim form, but only once each year for professional claims submitted on a CMS-1500 claim form.
Claims for diagnostic tests, test interpretations and certain other services do not require the beneficiary’s signature. Providers submitting these claims must indicate “patient not present” on the claim form.
Intellectually or physically disabled TRICARE beneficiaries age 18 or older who are incapable of providing signatures may have a legal guardian appointed or a power of attorney issued on their behalf. This legal documentation must include the guardian’s signature, full name, address, relationship to the patient and the reason the patient is unable to sign.
The first claim a provider submits on behalf of the beneficiary must include the legal documentation establishing the guardian’s signature authority. Subsequent claims may be stamped with “signature on file” in the beneficiary signature box of the CMS-1500 or UB-04 claim form.
If the beneficiary does not have legal representation, the provider must submit a written report with the claim to describe the patient’s illness or degree of behavioral disability and should annotate in box 12 of the CMS-1500 claim form: “patient’s or authorized person’s signature—unable to sign.” If the beneficiary’s illness was temporary, the signature waiver must specify the dates the illness began and ended. Providers should consult qualified legal counsel concerning signature requirements in particular circumstances involving mental or physical incapacity.