Provider Handbook

TRICARE
Eligibility

There are several identification and enrollment cards providers should be familiar with in order to verify a patient’s eligibility for TRICARE. Providers should ensure patients have a valid uniformed services ID card, Common Access Card (CAC), or authorization letter of eligibility. Be sure to check the expiration date and make a copy of both sides of the ID card for your files. (See “Copying ID Cards” later in this section.)

Note: An ID card alone is not sufficient to prove eligibility. Providers must verify the actual eligibility of the card bearer by accessing Humana Military’s Web site or by calling Humana Military at
1-800-444-5445. When verifying eligibility, be sure to use the sponsor’s Social Security number (SSN) found on the ID card. If you are verifying online, retain a printout of the eligibility verification screen for your files.

Beneficiaries can verify their eligibility in DEERS by calling 1-800-538-9552. Providers, however, may not verify TRICARE enrollment directly in DEERS because of the Privacy Act (Title 5, United States Code, Section 552a).

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The Department of Defense (DoD), in conjunction with the seven uniformed services, began issuing the uniformed services (military) ID card in 1994.

The uniformed services ID card is credit-card sized and incorporates a digital photographic image of the bearer, bar codes containing pertinent machine-readable data, and printed identification and entitlement information. The beneficiary category determines the ID card’s color:
 

• Active duty family members: 
  DD Form 1173 (tan)
• Family members of National Guard/Reserve members:
  DD Form 1173-1 (red) if eligible for TRICARE Reserve Select (TRS) or when accompanied by a copy of the sponsor’s activation orders for more than 30 days
• Retirees:
  DD Form 2 RET (blue)
• Retiree family members:
  DD Form 1173 (tan)
• TAMP-eligible members:
  DD Form 2765 (tan)

• Social Security Number or Sponsor SSN—Providers should use the SSN found on the ID card when verifying the card bearer’s TRICARE eligibility.

Note: Providers must verify the beneficiary’s eligibility by contacting Humana Military (as  described earlier in this section).

• Expiration Date—Check the expiration date on the ID card in the box entitled, “EXPIRATION DATE” (should read “INDEF” for retirees). If expired, the beneficiary will need to update his or her information in DEERS and get a new card. Eligibility for DoD benefits will be determined by the eligibility response received from DEERS and not the Identification and Privilege Card.

• Civilian—Check the back of the ID card to verify eligibility for TRICARE civilian care. The center section should read “YES” under the box entitled, “CIVILIAN.” If a beneficiary using TRICARE For Life (TFL) has an ID card that reads “NO” in this block, they are still eligible to use TFL if they have Medicare Part A and Part B.

Note: Eligibility may also be verified by a photo ID of the dependent when accompanied by a copy of the sponsor’s activation orders for more than 30 days.

Beneficiaries under the age of 10 are not routinely issued ID cards, so the parent’s proof of eligibility may serve as proof of eligibility for the child.

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