TRICARE

The TRICARE Overseas Program (TOP) is the Department of Defense (DoD) health care program for active duty US service members, retirees and their families, and certain other beneficiaries outside the US.

Why is the TRICARE Overseas Program (TOP) unique?

TOP manages a consistent, standardized program in over 200 countries by:

Assuring quality standards across country specific variances
Selecting the right mix of vetted health providers
Seeking care with required referrals and authorizations
Overcoming language and cultural barriers
Medical management for inpatient cases and primary health management for remote populations
Providing medical coding, billing and claims assistance
Obtaining preferred terms and discounts from health providers
Knowing how to meet regulatory and policy requirements
Long-standing experience managing highly sensitive data
Offering best-in-class aeromedical evacuation, even in austere or remote locations
Managing regional flight desks to supplement military airlift capability
Accessing a cashless network of 78,000+ actively managed, quality-assured and screened providers
Allowing for choice within the quality-credentialed network for specialty care and patient safety
International SOS TOP Regional Call Centers available 24x7x365 in three regional locations
Transparent reporting as well as cost management and control.

What the Program Offers:

Beneficiary Assistance Services

• Beneficiary Education
and Enrollment
• 24/7/365 Assistance on overall
Health Plan
• Medical Records Translation
Services
• Real-time Telephonic Language
Assistance

Case Management/ Medical
Oversight

• TOP Prime-enrolled Inpatient
Medical Management and Medical
Monitoring
• TOP Prime Remote Case Oversight
• Routine and Urgent Care
• Utilization Management
• Aeromedical Evacuation
• Medical Transports

Claims Processing

• ICD (International Classification
of Diseases) & CPT (Current
Procedural Terminology) Standard
Coding
• Translation of International Claims
• HIPAA Compliance
• International SOS Claims Audits

Referral/Authorization

• Referrals and Authorizations
• Beneficiary Eligibility and
Benefits Review
• Health Care Finder Service

Provider Network

• Credentialing & Quality Vetting
• Monitoring & Quality Control
• Localized Relationship
Management
• Leverage Commercial
Member Network
• Provider Education

"It is a true honor and privilege to serve our nation's military overseas, ensuring access to high-quality health care services no matter where their work or travels take them."
COL (Ret.) Rafael E. De Jesus, SVP Military Services, International SOS Government Services

TRICARE Overseas Program: Globally Integrated Health Care Delivery

The Differences between a Medically Managed Program and an Insurance Program

International SOS is a ‘doing’ company – not simply a ‘paying’ company. International SOS partners fully in the patient care; more than just transactional management and payment administration.

Success of the TOP is determined by having ‘boots on the ground’.

The key to this success is the network creation, right-sizing of that network, and constant management in the market, driving value, efficiency, innovation and partnership in every sense. This approach works by directing patients to providers who have practical knowledge and experience in the ability to deliver and help ensure quality medical outcomes.

Process to deliver high quality medical outcomes

Medical operations management contracts support intervention, case-management, and quality and capabilities oversight. This type of contract invests in the front end process of ensuring appropriate access for patients, positive medical outcomes and standardized global processing models allowing for a full and holistic view.

A typical insurance plan will often assume health care capabilities are equal and focus on the back end or payment for a more self-navigated care and localized

processing model.

A winning Partnership

Health care delivery under the TRICARE Overseas Program allows for transparency and partnership with US Defense Health Affairs leadership, ensuring access to quality health care by vetted, credentialed overseas providers even in the most austere challenging locations. The added complexities associated with foreign health systems, including instability and markedly fluctuating levels of quality of routine and specialty care require active patient care management to ensure compliance with the basic underlying TRICARE policy and expected US quality standards.

Links to Additional Information

TRICARE Overseas Program Contractor Website: www.tricare-overseas.com

TOP Beneficiary information: www.tricare-overseas.com/beneficiaries.htm and www.tricare.mil

TOP Education Products: www.tricare.mil/publications

"International SOS remains uniquely positioned to support the needs of international governments with medically-led, patient-first capabilities. Even in the most austere, hostile and challenging locations in the world, International SOS delivers quality health services efficiently and cost-effectively."
William Nelligan, CEO Governement Services - US, International SOS Government Services

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