Tricare Philippines Newsletter
The Double Proof of Payment Issue
The next scheduled newsletter was supposed to deal with the hospital
portion of inpatient claims. However we are still waiting on a response
on how beneficiaries can split the hospital portion out in the same way
providers split the claim. So not to delay any longer we opted to do
this newsletter pending the response.
About five years ago the DODIG, in an audit of the TRICARE Overseas
Program (TOP), found that beneficiaries in Europe were sometimes
allowed to not pay the provider pending processing of their claim but
that some were keeping the money and not paying the provider and,
because of that, some providers were no longer accepting TRICARE
patients. They recommended that the TRICARE Management Activity (TMA)
request proof of payment in cases where large claims were paid but
without a receipt showing proof of payment.
TMA took this recommendation and applied it to the Philippines
in a fashion not originally intended since they had already put in
place a requirement that we must submit receipts with our claims. (Only
within the last month or so has TMA extended this requirement to all of
TOP.) In our case, since we had already provided the proof of payment,
receipt, that the DODIG addressed, they now required of us some other
form of proof. Originally the only acceptable documents were credit
card receipts and cancelled checks. Given that the majority of
providers did not accept credit cards or charged high fees to use them
and checks are generally not used, beneficiaries were going to have a
problem meeting the requirement and find their claims denied for
failure to comply with the requirement. The U.S. Military Retirees of
group contested this requirement as unnecessary since proof of payment
was already provided and that the intent of the DODIG was to insure
beneficiaries in Europe who didn’t pay
the bill in advance did pay the provider. We also pointed out the
secondary or double proof of payment documents they specified we had to
use was as mostly not available. It turned out TMA was unaware of how
medical bills in the Philippines
While our challenge was rejected, TMA did agree to modify the list of
acceptable documents a beneficiary could use for double proof of
payment. TMA failed to publicize this requirement which has resulted in
some claims being denied for failure to provide the double proof of
payment and usually for large amounts of money.
The requirement still exists today although TMA still hasn’t published
any official information on the program. However, based on input from
TMA employees and Wisconsin Physicians Service (WPS) we do know when it
is currently applied and some acceptable alternatives for double proof
Double proof of payment is required when a claim meets one or more of
- An outpatient claim of $5,000
- An inpatient claim of $10,000
or more. (Combines both hospital and professional fees.)
- Claims submitted by
beneficiaries on pre-payment review.
- Claims from beneficiaries
where the provider is on pre-payment review.
What is pre-payment review?
TMA’s Program Integrity places
Philippine beneficiaries and providers on pre-payment review for
reasons that are kept secret. But we are told this happens when either
one is suspected of fraud against TRICARE. Any claim that involves a
beneficiary or provider on pre-payment review will trigger the double
proof of payment requirement at much lower thresholds. Program
Integrity likes to point to this program as their way of combating
fraud in the Philippines
and claims in published presentations that 82% of their total resources
are dedicated to this program in the Philippines
and 90% of WPS’s fraud effort is likewise
dedicated to Philippine fraud while only 16% of claims come from the Philippines.
Actual figures provided by TMA to Congress states that 77% of all
TRICARE beneficiaries in the Philippines
are on pre-payment review and 64% of all providers in the Philippines
are also on pre-payment review.
In our experience with talking to many beneficiaries about their claims
and assisting many others with processing their claims we haven’t come
across one example of a request for double proof of payment that was
triggered when the claim didn’t exceed item one and two thresholds
above. So we feel these figures are greatly exaggerated and primarily
for the consumption of those TMA wants to impress with their work and
perhaps justify their continued special rules for the Philippines.
If anyone has experienced this requirement with their claims we would
like them to contact us.
What is considered acceptable
double proof of payment?
The first requirement is that proof in an amount equal to or greater
than the total amount of the claim was obtained from some source within
a few days of the actual payments dates as shown by the previously
The latest feedback we have indicates that bank withdrawal slips,
credit card statements, credit card receipts and ATM receipts are
acceptable. Our experience also shows that bank statements showing the
withdraws, signed statements from those that loaned money so the
medical bill could be paid and even statements from adult children in
the states that sent money have been accepted. So our belief is that
WPS will try to work with beneficiaries on this requirement.
In a published presentation from TMA’s
Program Integrity that discusses the program they also list a signed
letter from the providers certifying that they were paid as acceptable.
However TMA has refused to respond to multiple requests asking to
confirm this approach. If someone is in a situation where they have no
other alternative they may want to see if this will work.
How do I prepare for this
Always consider this requirement whenever you are paying for medical
expenses. Make sure you have access to one or more of these acceptable
documents and maintain them with your records that support your claim.
This means to always retain all withdrawal slips, ATM and credit card
receipts and bank statements in the event that they may be needed.
After about 30 days from the time of the transaction and where no
medical expenses were paid you can discard them if not otherwise
Do not send in your double proof of payment along with the normal
receipts when you file the claim as they may not be considered
acceptable if they later request the information.
As we indicated before we intend to address how to file a claim for the
hospital portion of a hospitalization. That will depend, however, on
when we get the feedback we requested some time ago.
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