How is 115% of the TRICARE allowed amounts calculated when the beneficiary has primary other health insurance (OHI)?
You will need to look at the TRICARE Explanation of Benefits (EOB). This will explain what the allowed amount was for each service. Simply multiply the allowed amount by 115% and subtract out the OHI payment. Example: $100.00 (Amount Billed) $ 80.00 (TRICARE Allowable) x 1.15 (115%) = $92.00 – $30.00 (OHI Payment) = $62.
