Appeals Process Helps Answer Questions about TRICARE Claims

For many beneficiaries, understanding how TRICARE benefits are applied to doctors’ visits can be pretty cumbersome. But TRICARE beneficiaries may use the appeals process to request an appeal of any claim in question.

West region beneficiaries are encouraged to write their appeal formally to TriWest. The written appeal should include the following information:

• Sponsor’s name
• Sponsor’s Social Security Number
• Patient’s name
• Patient’s date of birth
• Claim number
• Date of service
• Provider name

When submitting an appeal, beneficiaries should also include a copy of the explanation of benefits (EOB) and clearly explain where the disagreement lies. Beneficiaries should include as much information as possible in order to expedite the appeals process.

Beneficiaries may submit an appeal to:
TriWest Healthcare Alliance
Claims Appeals
P.O. Box 86036
Phoenix, AZ 85080

It’s important to note that a claim may be appealed 90 days from the date the claim processed.

For more information on the TRICARE appeals process, please visit www.triwest.com or call 1-888-TRIWEST (1-888-874-9378).