TRICARE — 10 Steps for Filing a Claim

TRICARE Helpoffsite link in new window

1. ALWAYS ask your provider "Who is filing the claim?" If a TRICARE Prime or TRICARE Network provider gives your care, the provider will file the claim for you. If you are using a non-network provider, the provider may not be filing for you. Always ask.

Stethoscope and a piggy bank.

2. Use the DD Form 2642 and fill it out properly. The DD Form 2642 is the correct form for beneficiaries. You can get a DD Form 2642 from military hospitals, or from TRICARE Web Siteoffsite link in new window. If you do not know how to fill out this form, call your regional TSC and ask them to assist you.

3. Send the DD Form 2642 to the correct address. There are many different addresses for claims processors, based on your region and state of residence. Find the correct address through the TRICARE claims siteoffsite link in new window.

4. Submit your claim as soon as service is rendered. It is very important that you submit your claim as soon as possible. Submitting a complete and accurate claim quickly this will assure you payment in a timely manner. Managed care support contractors are required to process 95 percent of claims in 30 days, and 100 percent of claims not returned for error in 60 days. Claims must be received within one year of the date of service, unless you have a waiver.

5. Submit all claims separately; do not bundle them. Because processors manage claims separately, it is a bad idea to submit multiple claims. If there is a problem with one claim, they might all be held pending correction and payment will be delayed.

6. File with your other health insurance (OHI) FIRST. You or your provider must file a claim with your OHI before filing with TRICARE. After your other health insurance has paid, a claim may be filed with TRICARE. A copy of the OHI's payment determination and a copy of the itemized bill, must be sent with your TRICARE claim. Not telling either your TRICARE provider or the claims processor about OHI may result in a denied or delayed claim.

7. Make sure your DEERS information is current. If you don't appear in the DEERS data bank as eligible for TRICARE benefits, TRICARE will deny your claim. You can make sure this data is current by contacting your nearest military personnel office or DEERS (address corrections ONLY) at 1-800-538-9552.

8. Accident claims include DD form 2527. Were you hurt in an accident where someone else may be legally responsible? If so, they or their insurance may have to pay some or all of the medical bills. You or the provider can file claims with TRICARE right away, but be sure to point out on the claim that another person may be responsible. You'll have to complete and attach DD Form 2527 to all claims submitted before your claim can be processed.

9. Keep copies of everything you send to claims processors. It is important to keep copies information submitted to the claims processor, including paperwork from your OHI.

10. Resolve problems at the lowest level. Your TSC staff may be able to help you resolve the problem with only a phone call on your part.


page last modified on: 6/4/2014

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