Claims for beneficiaries using Medicare and TRICARE

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

TRICARE claims information