ALL TRICARE Overseas Program (TOP) Providers are required to collect a signature from their TRICARE patients (beneficiaries) prior to submitting a claim. It is recommended that TOP Providers collect the signature at the first appointment (for each episode of care) and to keep the patient’s signature on file (i.e., within the TRICARE patient’s records/files).

By signing the “Beneficiary Signature on File Form”, the beneficiary is validating:
1.That the medical services from the provider were rendered,
2.That all future claims for this episode of care are submitted on their behalf, and
3.Authorization to release medical information to International SOS for the purposes listed above.

On the Standard U.S. Government Claim Form CMS 1500 AND the Claim Development Worksheet (CDW), a patient signature is required to ensure accurate processing and payment. Rather than the beneficiary having to sign the Claim Form every time a claim is submitted on his or her behalf, the TOP Provider can indicate on the CMS 1500 Claim Form or the CDW that they hold a “signature on file.” An actual signature is then no longer required. TOP Providers may indicate “Signature on File” or “SOF” in the relevant fields of the claim forms and have their claim processed, only if the patient has signed the “Beneficiary Signature on File Form.”

Institutions that are submitting a UB-04 Claim Form are required to have a permanent hospital record containing a release statement on behalf of the beneficiary. Institutions are encouraged to follow this procedure, to ensure compliance with TRICARE Overseas Program (TOP) “Signature on File” requirements.

International SOS further recommends that the TOP Provider collect details of the patient’s sponsor details at the same time. The TOP Provider will need these details when completing the CMS 1500, CDW and UB-04 Claim Forms.