Filing A Claim

We are proud of our timely service

Filing your TRICARE Supplement claim will depend on whether or not you have selected a participating or non-participating provider and if the provider will or will not file your supplement claim. Your TRICARE Supplement Plan pays secondary to TRICARE. Therefore, your claims for medical expenses must be submitted to TRICARE for primary processing. After processing your claim, TRICARE will send you (and your provider if benefits were assigned) an Explanation of Benefit Statement (EOB). The TRICARE EOB shows the name of the service provider, date of service, billed amount, TRICARE Allowed Amount, payment, deductible and cost share amounts.

To obtain your supplement benefits, a claim should be submitted to Selman & Company either by you or your medical provider (doctor, lab, hospital, ambulance, etc.). Your claim must include the TRICARE EOB.

WHEN THE PROVIDER FILES THE CLAIM FOR YOU

Claim submission MUST include the following:
1. a claim form* (completed and signed) -and-
2. a copy of the provider's bill showing the diagnosis, provider's name, address and Tax Identification number -and-
3. a copy of the corresponding TRICARE EOB.

We often receive only the itemized bill and the claim form either from you or your provider. When Selman & Company receives the claim form and the itemized bill, we will acknowledge our receipt of these items and advise you and your provider (if benefits are assigned to provider) that the processing of the claim will be delayed pending receipt of the TRICARE EOB. Your TRICARE Supplement benefits are paid to you only when we have the provider's bill and corresponding TRICARE EOB. Supplement benefits are based on the TRICARE Allowed Amount and payment shown on the TRICARE EOB.

WHEN YOU FILE THE TRICARE SUPPLEMENT CLAIM

All of the above steps are followed except you are mailing us the claim form1, itemized bill with diagnosis and a copy of the corresponding EOB received from TRICARE.

FILING A CLAIM FOR PRESCRIPTION DRUG EXPENSES

Claims for prescription drug expenses should include either of the following. Please note that the prescription drug copayment receipt should show the name of the drug, prescribing physician's name, date prescription was filled and the copayment amount.
1. prescription drug copayment receipt (not the cash register receipt), -or-
2. a printout of your prescription copayments from your pharmacy, -or-
3. a copy of your TRICARE EOB.

FOR TRICARE PRIME SUPPLEMENT CLAIMS

If you are enrolled in TRICARE Prime, you may submit your completed claim form1 and copayment receipts for reimbursement. The copayment receipts must include the provider's name, date of service and copayment amount. When services are obtained under the TRICARE Point of Service (POS) option, the corresponding TRICARE EOB is required.

ALWAYS WRITE YOUR MEMBER IDENTIFICATION NUMBER ON EACH PAGE OF YOUR CLAIM

The member ID Number is the six to seven-digit number located on your ID card. If you would like claim benefit payment to be made to your provider, please write "Pay Provider" on the claim. Mail your supplement plan claims to the following address:

Selman & Company
PO Box 2510
Rockville, MD 20847

WHEN THERE IS A DELAY

Many claimants mistakenly believe that a request for additional information equates to a claim "denial". This is not the case. There is a difference between a claim "delay" and a claim "denial". A "delay" occurs when an incomplete claim is filed and additional information is required whether from the claimant or the provider of care. A "denial" occurs when a claim is filed and the charges incurred are specifically excluded by the supplemental policy. For example, a supplemental claim will be "denied" if TRICARE/CHAMPVA denies it as not being a covered service. (Refer to code 55 on reverse side of our sample Explanation of Benefits).

To tell if a claim is "delayed" or "denied" refer to the remarks column on the Selman & Company EOB. The code number in the remarks column corresponds to an explanation on the reverse of the Selman & Company EOB. For example, a common reason for delay in claims processing is the failure to submit the TRICARE EOB. In most cases, a supplement claim cannot be processed without the TRICARE EOB. If a claim cannot be processed for this reason, we will request the TRICARE EOB from you or your provider (if benefits were assigned to the provider). This request will be identified on the EOB by remark code 51, which states: "Please furnish us with a copy of the Explanation of Benefits for the payment by TRICARE/CHAMPVA so that we can determine our liability." We hope this explanation helps you to better understand the claim processing procedure. Call our toll-free number 1-800-638-2610, 9:00am - 7:00pm ET, Mon - Fri, if you have any questions. If it is necessary to leave a message, please provide your Member ID number and telephone number so that your call can be returned.