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Appeals, Third Party Liability,
Explanation of Benefits and
Debt Collection Assistance Officers
Appealing a Claim or Authorization Denial
TRICARE has a multilevel appeals process to address claim and authorization denials. You may appeal the denial of a requested authorization of services or TRICARE decisions regarding claims payment. Submit appeals to Humana Military. For more detailed information on the appeals process, see “Appealing a Decision” in the For Information and Assistance section or visit TRICARE's web site. Third Party Liability
The Federal Medical Care Recovery Act allows TRICARE to be reimbursed for treatment costs if you are injured in an accident caused by someone else. The Statement of Personal Injury Third Party Liability (DD Form 2527) will be sent to you if a claim appears to have third-party liability involvement. Within 35 calendar days, you must complete and sign this form and follow the directions for returning it to the appropriate claims processor. You can download DD Form 2527 at TRICARE's web site.
Explanation of Benefits
A TRICARE EOB is not a bill. It is an itemized statement that shows the action TRICARE has taken on your claims. An EOB is for your information and files.
After reviewing the EOB, you have the right to appeal certain decisions regarding your claims and must do so in writing within 90 days of the date of the EOB notice. You should keep EOBs with your health insurance records for future reference. (For more information about appeals, see the For Information and Assistance section.)
View a sample of a South Region EOB. 
Debt Collection Assistance Officers
Debt Collection Assistance Officers (DCAOs) are located at MTFs and TRICARE Regional Offices to help you resolve health care collection-related issues. Contact a DCAO if you received a negative credit rating or were sent to a collection agency due to an issue related to TRICARE services.
When you visit a DCAO for assistance, you must bring or submit documentation associated with a collection action or adverse credit rating, including debt collection letters, EOB statements, and medical and/or dental bills from providers. The more information you can provide, the faster the cause of the problem can be determined. The DCAO will research your claim, provide you with a written resolution of your collection problem, and inform the collection agency that action is being taken to resolve the issue. DCAOs cannot provide legal advice or repair your credit rating, but they can help you through the debt collection process by providing documentation for the collection or credit-reporting agency to explain the circumstances relating to the debt. To find a DCAO near you, visit the DCAO directory online. |
