Lesson 7 of 15
How claims are paid
Quick answer
Medicare-participating providers bill Medicare directly. Medicare pays its share and automatically forwards the claim to WPS (TFL's claims processor). WPS pays the remaining Medicare cost-share. You usually see two Explanation of Benefits documents and owe $0.
Key takeaways
- Most claims crossover automatically — no action needed.
- If a claim does not crossover, you can file with WPS using the claim form in the TFL Handbook.
- Always present your Medicare card AND Uniformed Services ID to providers.
- Keep all EOBs for at least one year in case of a dispute.
Detailed explanation
The crossover system
Medicare and WPS share data electronically. When a Medicare-participating provider submits a claim, the system identifies your TFL eligibility through your Medicare number and forwards the claim to WPS the same day.
When you might need to file
- A provider who is not signed up for electronic crossover (rare).
- Care received outside the U.S. that Medicare did not cover.
- A specific service Medicare denied but TFL may still pay on.
The TFL Handbook includes step-by-step instructions and the WPS claims address.
Disputing an EOB
If a claim was processed incorrectly, you can request a Medicare appeal first (the Medicare Summary Notice explains how) and then a TFL appeal if needed. Keep documentation.
Frequently asked questions
Who do I call if a claim is wrong?
Call the claims contact listed on the TFL EOB or on the back of your Uniformed Services ID. For Medicare-side issues, call 1-800-MEDICARE.
Official government resources
Official Medicare and TRICARE publications are the definitive source. This page is an independent educational summary; always confirm specifics against the resources above.