How to file a TRICARE Claim

Other Health Insurance (OHI) When you have OHI, claims must be coordinated with both your primary OHI and TRICARE. Here's how: Step 1: Your provider should submit claims to your primary insurer first. Most providers will submit the claim for you. Once the claim has been processed, both you and the provider will receive an explanation of benefits (EOB) indicating the amount paid by your primary insurer. Step 2: If TRICARE is the second payer, send a copy of the EOB from the OHI together with your claim to TRICARE for processing. If you have Medicare and TRICARE, send your claim to Medicare, which will then send the claim to TRICARE on your behalf for secondary processing.

As a TRICARE beneficiary, you may have to file your own claim or additional claim forms if you:

• use non-network, non-participating providers
• have other health insurance
• are injured at work, home, or in an accident

To ensure timely payment, follow these four steps:

1. First, update your information in the Defense Enrollment Eligibility Reporting System (DEERS). Errors in the DEERS database can cause problems with TRICARE claims, so it is critical to maintain your DEERS information. You can do this several ways:
   
   

   In person	At a military personnel office or uniformed services ID card-issuing facility
   Online	Updating DEERS
   Mail	Defense Manpower Data Center Support Office Attention:COA,400 Gigling Road, Seaside,CA 93955-6771
   Fax	DEERS at 1-831-655-8317
   Phone	1-800-538-9552, Monday-Friday, 6 a.m. to 3:30 p.m. PST

   
   
   
2. Once you have updated DEERS, TriWest will be notified automatically of any changes and will update your file accordingly.
3. Complete and sign the Beneficiary Claim Form (DD Form 2642). If you were injured at work, home, or in an accident, you'll also have to complete and attach DD Form 2527, Statement of Personal Injury—Possible Third Party Liability.
4. Attach a copy of the provider's bill to the claim form. Make sure the billing information includes the following:
   • The specific name/address of the person who treated you.
   • Date and place of each service
   • Description of each service or supply furnished
   • Charge for each service
   • Diagnosis (If the diagnosis is not on the bill, then complete block 8a on the DD Form 2642.)
   
   

   Submit Medical Claims to:	Submit Pharmacy Claims to:
   West Region Claims P.O. Box 77028 Madison, WI 53707-1028	Express Scripts, Inc. P.O. Box 66518 St. Louis, MO 63166-6518

   
   
5. Claims should be submitted within one year after the date of service. Claims submitted more than one year after the date of service require an explanation as to why they were not filed in a timely fashion and may not be paid.

For more information about how to file a TRICARE claim, go to www.TRICARE.mil or call 1-888-TRIWEST.