Medical Claims

Sometimes, you’ll need to file your own claims

(i.e. when traveling or getting care from a non-participating provider) or if you are living outside of the US or its territories.

If you do, send your claim form to TRICARE as soon as possible after you receive care. The sooner your claim and other paperwork are received, the sooner you or your provider will be paid.

  1. In the U.S. and U.S. territories, claims must be filed within one year of service.
  2. In all other overseas areas, claims must be filed within three years of service.
  3. You’ll be reimbursed for TRICARE-covered services at the TRICARE allowable amount. This amount won’t include any copayments, cost shares or deductibles.

How to File and Check Claims Status

Follow the steps below to file and check the status of your claims.

  1. Keep copies of all paperwork for your records.
  2. If you need help, call your regional contractor.
  3. Fill out the TRICARE Claim Form
  4. Download the Patient’s Request for Medical Payment [DD Form 2642](http://www.dtic.mil/whs/directives/infomgt/forms/eforms/dd2642.pdf).
  5. Fill out all 12 blocks of the form completely.
  6. Sign the form.

Include a Copy of the Provider’s/Pharmacy’s Bill. Attach a readable copy of the provider’s bill to the claim form, making sure it contains the following:

  1. Sponsor’s Social Security Number (SSN) or Department of Defense Benefits Number (DBN) (eligible former spouses should use their SSN). The bills that I have received do NOT contain my SSN. Maybe in the US they would, but not here in the Philippines.
  2. Provider’s name and address (if more than one provider’s name is on the bill, circle the name of the person who treated you)
  3. Date and place of each service
  4. Description of each service or supply furnished
  5. Charge for each service
  6. Diagnosis (if the diagnosis is not on the bill, be sure to complete block 8a on the form).

Submit the Claim

  1. Mail your completed claim form to the claims address for your claims processor. Remember, that if mailing from overseas it might take a long time for Tricare to receive your claim.
  2. If filing a claim overseas, you can submit your claim on-line. >>Learn More This is the way that I now submit my claims.
  3. You can also fax your claim to: + 1 608-301-2251

Check the Status of Your Claims. To keep track of your claims on-line, you’ll need to register on your claim processor’s site: Overseas

Once registered, you can: Look up your deductibles and your out-of-pocket expenses, update your other health insurance information, and view your explanations of benefits on-line.

Claim forms:

  1. Medical Claims
  2. Prescription Claims

This blog post is part of my FREE ebook that is available for download at tc-info.gerbreown.com

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