Champus/Tricare

Mayo will file your CHAMPUS/TRICARE primary claim and supply you with a supplemental claim form, if needed. Since Mayo Clinic participates with CHAMPUS/ TRICARE, payments are made to us.

CHAMPUS/TRICARE will normally pay 80 percent of the approved charges for active-duty military/dependents and 75 percent for retired military/dependents. CHAMPUS/TRICARE has specific payment restrictions for certain diagnostic services, utilization limits on visits or consultations and procedures that CHAMPUS/TRICARE deems not proven effective. You will be responsible for the 20- or 25-percent copayments, deductibles and any noncovered services.

There are three levels of TRICARE coverage

1. TRICARE STANDARD — Mayo Clinic is a participating provider.
2. TRICARE EXTRA — Mayo Clinic is NOT a TRICARE EXTRA provider.
3. TRICARE PRIME (HMO) — Without prior authorization, the patient will have a higher copay amount (usually 50 percent).

Physician Written Referral
A Physician Written Referral is required for inpatient admissions and some outpatient procedures. It's your responsibility to check with your local health-benefits adviser at a military treatment facility near you to find out if you need a Physician Written Referral.

Pre-Authorization
Pre-authorization is required for nonemergency hospital admissions and other outpatient procedures. Please refer to your TRICARE manual or call your military hospital's health-benefits adviser.

Questions and Answers about CHAMPUS/TRICARE

Does Mayo accept all levels of TRICARE?
No, only TRICARE STANDARD. TRICARE PRIME is only accepted with prior authorization.

Does Mayo file my supplement?
No, we will supply you with the claim form for filing.

Does Mayo obtain my Physician Written Referral (formerly called NAS)?
No, the patient is required to get the Physician Written Referral. We help you in this process.

Can an active-duty member be seen at Mayo Clinic?
Yes, but only with a referral from the member's commanding officer. You must bring your uniform services ID card.

As a dependent or retired member, will I need my ID card?
Yes, a valid ID card is required.