Navigating the Claims Process
Filing your own claim for health care can seem like an overwhelming task – keeping all the paperwork together and submitting the right forms to the right address within the allowed time frame is all that is necessary to successfully submit a TRICARE claim.
As a TRICARE beneficiary, you may find yourself having to file your own claim if:
- The provider does not submit a claim for you (if you use a non-network, non-participating provider)
- You have other health insurance
- You are injured in an accident, at work or at home
If you need to file a claim yourself, follow these steps:
- Stay up-to-date
- Errors in the Defense Enrollment Eligibility Reporting System (DEERS) can cause problems with your TRICARE claims—always keep your family information updated in DEERS and with TriWest
- Do the paperwork
- 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 a Statement of Personal Injury—Possible Third Party Liability (DD Form 2527)
- Submit the claim
- With the claim form, send in a copy of the provider’s bill making sure the bill includes:
- Specific name and address of the person who treated you
- Date, location (address) and the description of each service provided
- Charge for each service
- Diagnosis—if the diagnosis is not on the bill, you will have fill out block 8a on the Beneficiary Claim Form (DD Form 2642)
- With the claim form, send in a copy of the provider’s bill making sure the bill includes:
Claims can be submitted up to one year from the date of service. Those claims submitted after one year will require an explanation of why they were submitted past the timely filing limit and may not be considered for payment.
Submit your medical claims to:
WPS
West Region Claims
P.O. Box 77028
Madison, WI 53707-1028
Send pharmacy claims to:
Express Scripts, Inc.
P.O. Box 66518
St. Louis, MO 63166-6518