It is important to know the signature on file requirements when dealing with TRICARE patients.
When a TRICARE beneficiary has signed a Release of Information statement, you should indicate “signature on file” in Box 12 of the CMS-1500. A new signature is required every year for professional claims submitted on a CMS-1500 and for every admission for claims submitted on a UB-04.
If the beneficiary is under age 18, the parent or legal guardian should sign the claim. However, a beneficiary under age 18 may sign the claim form if the beneficiary is (or was) the spouse of an active duty Service member (ADSM) or retiree, or if the services are related to venereal disease, drug or alcohol abuse, or abortion.
In situations when a beneficiary is mentally incompetent or physically incapable, the person signing should either be the legal guardian or, in the absence of a legal guardian, a spouse or parent of the beneficiary. See the Important Provider Information section of the Provider Handbook for more information about the release of patient information.
If the beneficiary is deceased, and you do not have a valid signature-on-file agreement, you must submit one of the following:
- A claim form signed by the legal representative of the estate.
- Documentation accompanying the claim form to show the person signing is the legally appointed representative.
- If no legal representative has been appointed, the parent, spouse, or next of kin may sign the claim form. The signer must provide a statement that no legal representative has been appointed. The statement should contain the date of the beneficiary’s death and the signer’s relationship to the beneficiary.
- In the event there is no spouse, parent, or guardian to sign the claim form, the claim must be signed by the surviving next of kin or a legally appointed representative (indicate relationship to beneficiary).
- When there is no spouse, parent, guardian, next of kin, or legal representative to sign the claim form for a deceased beneficiary, payment may be made to the provider in accordance with state law and TriWest corporate policy.
Signatures from the following individuals are not acceptable as beneficiary signatures:
- A provider or an employee of an institution rendering care
- An employee of an entity submitting a claim on behalf of a beneficiary, unless such employee is the beneficiary’s parent, legal guardian, or spouse
Claims submitted for diagnostic tests, test interpretations, or other similar services do not require the beneficiary’s signature. When submitting these claims, you must indicate “patient not present” on the claim form.
TRICARE randomly reviews claims to help ensure that signature-on-file requirements are being followed.
For more information, please refer to the Provider Handbook, which can be found at TriWest.com/Provider.