Wisconsin Physicians Service/TRICARE Dual-Eligible Fiscal Intermediary Contract (WPS/TDEFIC) is the claims processor for all TRICARE For Life (TFL) claims. Providers who currently submit claims to Medicare on a beneficiary’s behalf do not need to submit a claim to WPS/TDEFIC. WPS/TDEFIC has signed agreements with each Medicare carrier allowing direct, electronic transfer of TRICARE beneficiary claims to WPS/TDEFIC. Beneficiaries and providers will receive EOBs from WPS/TDEFIC after processing.
Note: Participating providers accept Medicare’s payment amount. Nonparticipating providers do not accept Medicare’s payment amount and are permitted to charge up to 115 percent of the Medicare-approved amount. Both participating and nonparticipating providers may bill Medicare.
When TRICARE is the primary payer, all TRICARE requirements apply. Refer to the TRICARE Reimbursement Manual, Chapter 13