In most cases, you will not need to file claims for health care services. There may be times, however, when you will need to pay for care and then file the claim to receive payment. You will be reimbursed for TRICARE-covered services at the TRICARE allowable charge, less any copayments, cost-shares, or deductibles.
Claims must be filed within one year of the date of service or within one year of the date of an inpatient discharge. To file a claim, obtain and fill out a DD Form 2642 Patient’s Request for Medical Payment. You can download forms and instructions from the TRICARE Web site. If you have questions about a claim, call Humana Military.
When filing a claim, attach a readable copy of the provider’s bill to the claim form, making sure it contains the following:
The sponsor’s Social Security number
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.)
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, be sure to complete block 8a on the form.)
Be sure to complete all 12 blocks of the form correctly and sign it. Note: Your provider will submit inpatient facility claims.
Send your claims to the claims processor for the region in which you live. If you receive care while traveling, you must file your TRICARE claims in the region in which you live, not the region in which you received care. Always keep a copy of the paperwork for your records. Figure 5.1 lists regional claims processing information.
You may call Humana Military or visit the TRICARE Web site for additional claims processing information.
