0720-0006_Web Submission Pharmacy Claims.pptx

TRICARE DoD/CHAMPUS Medical Claim Patient's Request for Medical Payment

0720-0006_Web Submission Pharmacy Claims.pptx

OMB: 0720-0006

Document [pptx]
Download: pptx | pdf

Direct Claims Self Service (DCSS)
DoD

Proposed Approach, presented Nov 2021

 

 

<number>

 

<number>

<number>

<number>

 

Informational Claim Page

 

Starting a Direct Claim – Select Your Claim

 

Starting a Direct Claim – Regular vs COB

 

Starting a Direct Claim - Regular

 

Starting a Direct Claim - COB

 

Prescription Information

 

Prescription Information

 

Contextual Help

 

Retail Pharmacy

 

Retail Pharmacy

 

Receipt Upload

 

Review & Submit

 

Close Prompt

 

Confirmation

 

Pending Additions

  • The following will be presented on a new screen, either at the beginning of the process or the final submission screen: 

    • Privacy Act Statement 

    • OMB Approval Number 

    • OMB Approval Expiration Date 

    • Agency Disclosure Notice 

 
File Typeapplication/vnd.openxmlformats-officedocument.presentationml.presentation
File Modified0000-00-00
File Created0000-00-00

© 2024 OMB.report | Privacy Policy