How TFL works

Medicare becomes the primary payer, so referrals and prior authorizations from Humana Military are usually not required. However, dual-eligible beneficiaries may need an authorization from Humana Military if Medicare benefits are exhausted or for care covered by TRICARE but not Medicare. Learn more about TRICARE referral and authorization requirements

File TFL claims first with Medicare. Medicare pays its portion and electronically forwards the claim to WPS/TDEFIC (unless the beneficiary has OHI). WPS/TDEFIC sends its payment for TRICARE-covered services directly to the provider. Beneficiaries receive Medicare summary notices and TRICARE Explanation Of Benefits (EOBs) indicating the amounts paid:

  • For services covered by both TRICARE and Medicare: Medicare pays first and TRICARE pays its share of the remaining expenses second (unless the beneficiary has OHI).
  • For services covered by TRICARE but not by Medicare: TRICARE processes the claim as the primary payer. The beneficiary is responsible for the applicable TFL deductible and cost-share.
  • For services covered by Medicare but not by TRICARE: Medicare is the primary payer and TRICARE pays nothing. The beneficiary is responsible for the applicable Medicare deductible and cost-share.
  • For services not covered by Medicare or TRICARE: The beneficiary is responsible for the entire bill.
View more about claims processing and billing for TFL claims and coordinating with OHI
  

TFL resources