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Electronic Filing Process for MEDIPLUS® TRICARE Supplement Claims

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January 22, 2014

MOAA is proud to offer DirectClaim - an electronic filing process for members' MEDIPLUS TRICARE Supplement claims. The DirectClaim process handles most eligible claims quicker, pays faster and reduces the need for members to complete MEDIPLUS claim forms and submit them with their TRICARE Explanation of Benefits (EOB) forms.

Mercer Consumer, a service of Mercer Health & Benefits Administration LLC, the MOAA TRICARE Supplement Insurance Plans Administrator, has worked directly with the intermediaries that process TRICARE claims, to develop electronic filing of MEDIPLUS TRICARE Supplement claims.

With DirectClaim, MOAA members do not have to complete MEDIPLUS claim paperwork or submit an EOB form after they access most of their eligible TRICARE benefits. Note: Some TRICARE Supplement claims cannot be processed electronically. All prescription claims and most skilled nursing or skilled nursing facility, nursing home claims and claims filed from overseas cannot be filed electronically. For these, you will need to submit paper claim filings to MEDIPLUS. Claim forms are accessible on the MOAA Insurance Plans Web site at www.moaainsurance.com.

When TRICARE providers submit claims to the TRICARE intermediary, the intermediary will electronically send the EOB, if it qualifies, to Mercer Consumer for processing under MEDIPLUS. Members no longer have to wait to receive the EOB from TRICARE or spend time completing and sending a MEDIPLUS claim form to Mercer Consumer.

If a claim for service is submitted through DirectClaim and TRICARE has paid the provider(s) directly, any payment due under a MEDIPLUS TRICARE Standard Supplement will be paid directly to the provider(s). Under TRICARE Prime, most network providers require the patient’s $12 co-pay at the time of the office visit, so the MEDIPLUS TRICARE Prime Supplement reimbursement of those Prime outpatient co-pays will be sent directly to the member. Only the Prime $12 co-pay for office visits will be reimbursed to the member. All other Prime co-pays will be reimbursed to the provider.

It is important that the MEDIPLUS participant’s name appears on their MEDIPLUS file the same as it is on their military ID card to ensure proper claims processing.

To make sure your claim information is kept confidential, DirectClaim is fully compliant with the Health Insurance Portability and Accountability Act (HIPAA), which means it follows the federal requirements to ensure privacy and security of patient information.

 

If you have any questions about DirectClaim, please call the MOAA Insurance Plans Administrator toll-free at 1-800-247-2192 or contact them via email at moaa.service@mercer.com

Considering the switch to MEDIPLUS?

Nearly 1 in 2 MOAA Members under age 65 rely on MEDIPLUS' TRICARE Supplement Plans to help protect their families. And now, with DirectClaim, MEDIPLUS is an even better value. To find out more information (including costs, exclusions, limitations and terms of coverage) and to enroll online, visit the MOAA Insurance Plans website and click on the TRICARE Supplement link.