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CLAIMS WITH MEDICARE OTHER PAYER CANNOT BE SENT TO THIS PAYER, PLEASE USE TRICARE FOR LIFE

Rejection Message Rejection Details Resolution
CLAIMS WITH MEDICARE OTHER PAYER CANNOT BE SENT TO THIS PAYER, PLEASE USE TRICARE FOR LIFE

This rejection means that standard Tricare payers (North region, South region, etc.) do not accept claims that have other payer of Medicare.

These claims must be submitted through Tricare For Life. 

Submitter Action:

1. Verify that the patient's other policy is a Medicare policy. 

2. Verify that the claim was submitted to the correct payer ID.

Follow the instructions below to verify (or edit) the payer ID associated with the claim.

1. Click Encounters > Track Claim Status.

2. Look for and double-click on the encounter that needs correcting.

3. Double-click on the Case and verify that the patient's other policy is a Medicare policy. 

4. Double-click on the Tricare Insurance Policy.

5. Double-click on the Insurance name to open the Edit Insurance Plan page.

6. Double-click on the Insurance Company name to open the Edit Insurance Company page.

7. Click the Electronic Claims tab.

The current payer ID is listed in the Clearinghouse Payer ID field. If the payer ID the claim is being billed to is incorrect it can be updated in two ways:

1. By changing the payer ID associated with this insurance company: 

Note: Changes made within the Edit Insurance Plan or Edit Insurance Company pages will apply to ALL insurance policies and claims tied to that Insurance Plan or Company within the practice.

a. Click the Electronic Payer Connection button.
b. Search for and select the correct payer ID for Tricare For Life.
c. Click Save all the way out (multiple saves may be required).

2. By associating the insurance policy with another insurance company (with the correct payer ID):

a. Exit back to the Insurance Policy page. 

b. Click the Insurance button.

c. Look for an Insurance Plan with the correct payer ID for Tricare For Life (listed under the “EDI Payer Number” column).

  • If there are no insurance plans associated with the correct payer ID a new insurance plan and insurance company will need to be created. 

​d. ​Double-click on the appropriate insurance plan to associate it with the patient’s insurance policy.

e. Verify all other information listed on the policy is correct.

f. Click Save all the way out (multiple saves may be required).

Then, rebill and resubmit all affected claims. 

Note: Please verify enrollment is completed (or not needed) before submitting e-claims to a new Payer ID.