Covering Providers

TriWest has recently received inquiries about reimbursing a provider if they are "covering" for a network provider.

TriWest or TRICARE uses modifier Q6 to identify that the provider is "on call." No matter if the "on call" provider is network or non-network, a provider should bill modifier Q6 when they are rendering services as a covering provider.

Provider types that can bill "on call" are the following primary care specialties:

• General Practice
• Family Practice
• Internal Medicine
• Pediatrics
• OB/GYN

If the covering provider is a non-certified TRICARE provider and is billing the Q6 modifier, WPS will certify the provider and the provider will be paid at the non-network rate.

The covering provider must bill under their own Tax Identification Number (TIN). Providers may not bill services with another provider’s information. The rendering provider’s information must be on the claim.

For more information, please refer to the Claims and Reimbursement area of the Provider Connection section of www.triwest.com.