D - -D

June 2013
Important TOP Updates
Welcome to the June 2013 edition
of the TRICARE Overseas Program
(TOP) Provider Newsletter.
We are pleased to introduce a new
editorial feature, spotlighting an
International SOS Network Provider
delivering care under the TRICARE
Overseas Program.
This edition includes an in-depth
interview with Dr. Niko Mihic, a
General Practitioner in Madrid,
Spain (see pp.1-2).
If you are interested in being
featured in a future TOP Provider
Newsletter, please contact your
TOP Regional Call Center and
press Option #5 to speak with a
member of the TOP Provider
Support Services team.
Also included in this edition are
articles regarding the following
 Abortion as a TRICARE
Covered Service Under
Certain Circumstances
 Ensuring Physical Therapy
Claims are Submitted
 Cervical Cancer Screening
Guidelines and Updates
 TRICARE Latin America &
Canada (TLAC) Prime
Provider Events in Puerto
Rico (April 2013)
International SOS is available to
assist you 24 hours a day, 365
days a year.
Contact us if you have any
questions regarding authorized
care, approvals and referrals, or
TRICARE covered benefits,
limitations and exclusions.
Dr. Niko Mihic
General Practitioner
International SOS
Network Provider
When contacting your TOP
Regional Call Center, you will
receive the following menu options.
Knowing these options ahead of
time will help expedite your request.
Option #1
Option #2
Option #3
Option #4
Option #5
Option #6
Emergency Care
Claims Support
Beneficiary Support (GTSC)
Provider Support Services
TOP Prime Remote Wellness
On behalf of the entire
International SOS organization and
our TOP Regional Medical
Management staff worldwide,
thank you for the very important
care you provide to TRICARE
beneficiaries overseas.
Ken McDonnell, MD
Medical Director,
TRICARE Global Operations
Please remember the many
advantages and benefits of signing
a Mutual Cooperation Protocol
(MCP) with International SOS.
Dr. Niko Mihic is a General
Practitioner and International SOS
Network Provider delivering care to
TRICARE Overseas Program
(TOP) beneficiaries in and around
Madrid, Spain.
Having served the local and
international patient community in
the Spanish capital since 1988, Dr.
Mihic offers internationally
oriented, integrated medical care
services to TOP beneficiaries living
in and around Madrid.
Dr. Mihic studied and worked in
the United States and Canada for
15 years, which makes his
experience and multi-cultural
awareness extremely valuable to
International SOS.
In addition to operating two inhouse hospital offices in H.M.
Sanchinarro and H.M.
Monteprincipe, Dr. Mihic also
serves as a contracted physician
at the Retamares NATO (North
Atlantic Treaty Organization) Base
as well as Medical Advisor for
various Global/Fortune 500
Latin America & Canada
Puerto Rico
Recently, International SOS’
Eurasia-Africa TOP Provider
Support Services team interviewed
Dr. Mihic to learn more about his
experiences treating TRICARE
beneficiaries overseas.
As we found out, what Dr. Mihic
likes most about working with TOP
beneficiaries is the ‘added variety
of dealing with a community of
international diverse patients,’
which makes him feel as if he’s
working at home.
“I receive great support from
International SOS all around!”
Additionally, he values the great
support of International SOS as
the TOP contractor on all fronts,
including ‘the effective,
streamlined administrative
processes for TOP
Authorizations and TOP Claims
improved TOP Claims
procedures through Electronic
Funds Transfer (EFT).
As an International SOS Network
Provider accepting EFT payment
for TOP Claims, Dr. Mihic receives
automated EFT Notifications,
which are sent with each EFT
payment and help to reconcile
outstanding claims at a glance.
International SOS’ support and
these streamlined processes help
him ‘provide all that’s needed on
a patient-to-patient basis.
Thank you Dr. Mihic and your
entire administrative staff for
all you do on behalf of TOP
beneficiaries every day!
One important milestone in the
TRICARE Overseas Program,
which Dr. Mihic acknowledged is
the ‘faster turnaround of TOP
Authorizations’ as well as
Electronic funds transfer (EFT) and
Automated Clearing House (ACH)
payments offer several key
advantages over paper checks,
including speed and security.
EFT is an electronic reimbursement
procedure that allows TOP Providers
to be paid for TOP Claims via the
global banking system. Payments are
deposited directly into the TOP
Provider’s bank account on a weekly
basis by the TOP Claims Processor
(via Citibank N.A.). Payment via EFT
is available in most countries.
Automated Clearing House (ACH) is
yet another alternative process,
whereby electronic payments are
deposited directly into the TOP
Provider’s bank account. The
payment is made by the TOP Claims
Processor once every week.
ACH differs slightly from EFT, as the
payment is cleared through a local
clearing process.
Note: ACH payments are currently
only available in a limited number of
currencies and countries.
The key advantage of ACH (versus
EFT) is that the fees charged to
TOP Providers (by their local bank)
for receiving ACH payments are
normally significantly lower than the
fees charged for receiving EFTs.
If you are interested in learning more
about EFT or ACH TOP Claims
reimbursement/payment options,
please contact your TOP Regional
Call Center and press Option #5 to
speak with a member of the TOP
Provider Support Services team.
Please verify with your bank for
actual fees charged for receipt of
ACH versus EFT payments.
ACH payments are processed via
batches in large volumes. Banks
receive their ACH transactions all at
once, processing them as a single
transaction and simplifying the
process. As a result, ACH
payments may take 1-4 days longer
than EFT payments to reach your
bank account.
Note: ACH payments are currently only available in 11 currencies and in 21 countries, including: Australia, Austria,
Belgium, Canada, Denmark, Finland, France, Germany, Greece, Hong Kong, Italy, Ireland, Netherlands, New Zealand,
Norway, Portugal, Singapore, Spain, Sweden, United Kingdom, United States, and U.S. Territories. For more information,
contact International SOS.
Latin America & Canada
Puerto Rico
As stated in the TRICARE Policy
Manual (TPM) Chapter 7, Section
18.1 (General Rehabilitation),
TRICARE will allow any
rehabilitative therapy that will
improve, restore or maintain
function OR to minimize or prevent
deterioration of function of a patient
when prescribed by a physician.
When TOP Providers invoice for
Physical Therapy services and use
an unclear narrative description or
procedure code such as 97039
(Physical Therapy Treatment) OR
they do not attach an itemized
breakdown showing exactly which
Physical Therapy services were
provided, the TOP Claim may be
pended or denied.
TOP Providers delivering Physical
Therapy services are reminded to
include a descriptive CPT
(current procedural terminology)
code on the invoice. If this is not
possible, then it is important to
include a written description of
each Physical Therapy service
Note: Even if a general description
is included on the invoice, the TOP
Claims Processor may not be able
to reimburse the Provider because
some services may be covered
under TRICARE Policy while
others are not. Therefore, services
should be itemized and broken out
individually (i.e., not bundled).
According to the TRICARE Policy
Manual (TPM), Chapter 7,
Section 18.1 (Exclusion D),
bundling of Physical Therapy
services (programs) as allinclusive is not appropriate or
Physical Therapy services
delivered during such a
program/encounter must be
itemized and each service
reviewed to determine if it was
delivered by an authorized
individual professional provider, if it
is a TRICARE covered benefit, and
whether it is medically necessary
and appropriate.
According to the TRICARE Policy
Manual, Chapter 4, Section 18.3,
abortions are now considered a
TRICARE covered procedure
when the following circumstances
are met (and documented):
 In a case in which the
pregnancy is the result of an act
of rape or incest.
 When the life of the mother
would be endangered if the
fetus were carried to term.
To ensure that TRICARE
reimburses the claim, the
following G7 modifiers and
medical condition codes must be
included on the CMS 1500 or
UB-04 Claim Forms:
 AA: Abortion performed due to
 AB: Abortion performed due to
 AD: Abortion performed due to
life threatening physical
A medical care brief on this topic
will be available on www.tricareoverseas.com Visit the Providers
section of this website for more
information or contact your TOP
Regional Call Center and press
Option #5 to speak with a
member of the TOP Provider
Support Services team.
Latin America & Canada
Puerto Rico
New evidence-based
recommendations for Cervical
Cancer Screening were published
in 2012 by:
 United States Preventative
Services Task Force (USPSTF);
 American Cancer Society
(ACS), the American Society for
Colposcopy and Cervical
Pathology (ASCCP), and the
American Society for Clinical
Pathology (ASCP);
 American Congress of
Obstetricians and Gynecologists
These evidence-based
recommendations include:
 Begin cervical cancer screening
at age 21
 Women ages 21-29 years
should be screened with
cytology alone every 3 years
 Women ages 30-65 years
should be screened with
cytology and HPV testing
(‘‘cotesting’’) every 5 years
(preferred) or cytology alone
every 3 years (acceptable)
 Women over 65 years of age
with evidence of adequate
negative prior screening and no
history of CIN2+ within the last
20 years should not be
screened for cervical cancer
with any modality
 Women at any age following a
hysterectomy with removal of
the cervix who have no history
of CIN2+ should not be
screened for vaginal cancer
using any modality
International SOS recently hosted
two TOP Prime Provider Educational
Seminars in Puerto Rico.
The events were held in Aguadilla
and Ponce respectively on April
22 and April 25, 2013.
Topics included:
 Authorizations and Referrals
 TOP Claims
 TRICARE Covered Services
 TOP Provider Support Services
 Secure Claims Portal Registration
 Frequently Asked Questions
TLAC Providers who attended were
able to meet International SOS
Network Management Services and
TOP Claims staff personally.
Note: The waivers apply to claims
with dates of service beginning
January 1, 2013.
The seminars were well attended
by International SOS Network and
TRICARE Participating Providers
in the TRICARE Latin America and
Canada (TLAC) area.
The open exchange of information
was helpful and attendees left with a
better understanding of the
TRICARE Overseas Program and
the many educational resources
available to them as they treat
TRICARE beneficiaries overseas.
Government personnel from
several Puerto Rico Military
Treatment Facilities (MTFs)
attended as well and were able to
meet and interact with
International SOS’ Network
Currently, there are waivers in
place authorizing the payment of
private room charges for Active
Duty Service Members (ADSMs)
receiving inpatient care in the
following countries only:
 Haiti
 Cuba
 Venezuela
 Columbia
 Peru
 Brazil
 Guatemala City, Guatemala
 Amman, Jordan
According to Title 32, Code of
Federal Regulations (CFR), Part
199.4(b) (5) (i) (A), a private room
is defined as a room with one bed
that is designated as a private
room by the hospital or other
authorized institutional provider.
If you have any questions
regarding these country-specific
private room charge waivers,
International SOS authorizations,
or how to submit TOP Claims for
these services, please contact
your TOP Regional Call Center
and press Option #5 to speak with
a member of the TOP Provider
Support Services team.
International SOS Assistance, Inc.
(http://www.internationalsos.com) is
the world’s leading medical & security
services company operating from over
700 sites in 70 countries with 10,000
employees, led by 1,100 physicians
and 200 security specialists. Our
global services include medical and
risk planning, preventative programs,
in-country expertise and emergency
response for travelers, expatriates and
their dependents of over 70 percent of
the Fortune 500 companies.
Since 1998, International SOS has
supported TRICARE in ensuring that
Active Duty Service Members and their
families receive the highest quality
care, no matter where their work or
travels take them.
“TRICARE is a registered trademark of the TRICARE Management Activity. All rights reserved.”
Latin America & Canada
Puerto Rico