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Tricare revenue codes for Residential Treatment

Shondell 2 years ago in Billing/Electronic Modules updated by anonymous 2 years ago 11

Has anyone else billed Tricare for Residential Treatment?  No matter what revenue code I use, Tricare is rejecting my electronic claims and I cannot get them to go through.

We only have one Tricare kid in our residential program. We bill code 1001. I remember us having trouble billing this because they were only accepting professional claims but that code is sent out as a institutional claim. I believe we had to change a setting in order to get the claim to process.

I am billing the 1001 as well.  I have tried the HCPCS H0019 and T2048 with it but they haven't worked.

I have tried professional claims with H0019, but had the same problem.

with Tricare, you must be a participating provider.......  they will not pay unless you are. 

We cannot become a Tricare provider because we are not JCAHO certified.  All I want is a denial so I can bill Medicaid.

We had the same issue. We knew Tricare would deny because we are not a participating provider. We ended up having to ticket Procentive to guide us through the settings and where the claim was getting caught along the way. This may be worth a shot on your end since I cannot remember exactly what we had to do. I do know that whatever we did worked because we received the denial and were able to bill the secondary insurance.

There is a code to put on claims that are submitted for denial...  I cannot remember if it is a value code or occurrence code.... sorry.  I just know there is a code that will flag them to give a denial.


Would this be what you are talking about? My co-worker found this link:

https://www.resdac.org/cms-data/variables/claim-related-occurrence-code

Code 24 and 25 seem line they would be the most beneficial when it comes to these services but we have never heard of this type of code before.

It is Condition code 21 :  Billing for Denial Notice.

I am trying to bill Tricare North 1002 and they keep rejecting they told me I need to look in the Uniform billing editor book and it will tell me how to bill residential but I don't have one. Did anyone get their claims to process since the last post? I have a precert and we are authorized to provide the care but every time I bill they reject it.

+1

We have to bill code 1001 for inpatient services billed to Tricare.