Line of Duty for Providers

Reserve Component (RC) members with approved Line of Duty (LOD) won’t show eligibility in our eligibility and enrollment system. LOD eligibility isn’t reflected in the contractor’s system.

RC members should have approved authorizations for care under the LOD. The regional contractor’s system will reflect authorizations. 

Do you have questions about specialty careSpecialized medical/surgical diagnosis, treatment, or services a primary care provider isn’t qualified to provide. referrals for a Reserve Component member under an LOD episode of care? Contact your regional contractor.

LOD coverage and Other Health InsuranceHealth insurance you have in addition to TRICARE, such as Medicare or an employer-sponsored health insurance. TRICARE supplements don’t qualify as "other health insurance." (OHI)

TRICARE pays as the only claims processer for approved LOD care. The care must match the authorization.  RC members won’t have a co-payment or cost-shareA percentage of the total cost of a covered health care service that you pay. for any approved LOD care. 

Claims

Although the RC member won’t show eligible, you must file the claim with the appropriate contractor.  We can’t make payments for claims which aren’t in the system. They may deny initially due to ineligibility. But we will initiate a claim reimbursement adjudication. 
If you’re experiencing issues with electronic claims filing, please contact your regional contractor.