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Immunizations Benefit Information Claims Information Vaccines Vaccines & Children Flu
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Immunizations & Claims
 

Keep Your Receipt
 

If you are required to pay out of pocket for the immunization or vaccine, you will want to keep your receipt if you wish to file a claim to be reimbursed.

Filing a Claim?
 

If you are using a network provider, your provider will submit claims on your behalf.  If you are using a non-network provider you may be required to submit your own health care claims if you wish to be reimbursed.
 
For TRICARE Prime and Extra beneficiaries, your provider will submit claims on your behalf. If you are using the TRICARE Standard option, you may be required to submit your own health care claims.
 
To file a claim, obtain and fill out a Claim Form Patient's Request for Medical Payment.
  •  When filing a claim, attach a readable copy of the provider’s bill to the claim form, making sure it contains the following: 
     
    • Sponsor’s Social Security number (SSN) (Eligible former spouses should use their 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 service
       
    • Description of the service
       
    • Charge for the service.
       
    • Diagnosis (If the diagnosis is not on the bill, be sure to complete block 8a on the form. For Immmunizations, "preventive service" can be entered).
 
Be sure to complete all 12 blocks of the form correctly and sign it.
 
You may be required to pay up front for services if you see a non-network TRICARE-authorized provider who chooses not to participate on the claim. In this case, TRICARE will reimburse you directly for the TRICARE allowable charge minus any applicable deductible and cost-share. Remember that nonparticipating providers may charge you up to 15 percent above the inpatient TRICARE allowable charge for services in addition to your cost-share and/or deductible.
 
Send your claims to the claims processor for the region in which you live.  If you live in the South Region send your claims to:
 
TRICARE South Region
Claims Department
P.O. Box 7031
Camden, SC 29020-7031
 
Be sure to keep a copy of the paperwork for your records.  If you live in the South region and have a question regarding claims processing, you may call Humana Military's claims processor, PGBA, at 1-800-403-3950.  Check the status of your claim at the PGBA Web site or login to MyHMHS.
 
Last Reviewed: June 29, 2011