Health Care and Pharmacy Claims
Health Care Claims
If you are using the TRICARE Extra option, 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. Claims should be submitted to the claims processor in the region in which you live.
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. If you have claims questions, 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:
- 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 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: Providers submit inpatient facility claims.
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 TRICARE allowable charge for services in addition to your cost-share and/or deductible.
Send your claims to the claims processor for the South region. If you receive care while traveling, file TRICARE claims based on where you live, not where you received care. Be sure to keep a copy of the paperwork for your records. Figure 4.1 lists regional claims processing information.
You may call Humana Military, visit the Claims section online, or visit the TRICARE Web Site for claims processing information.
Figure 4.1 Regional Claims Processing Information
Send claims to:
TRICARE South Region
Claims Department
P.O. Box 7031
Camden, SC 29020-7031
Check the status of your claim.
Pharmacy Claims
If you have other health insurance (OHI) with pharmacy coverage or if you fill prescriptions at a non-network pharmacy, you’ll need to submit pharmacy claims to Express Scripts, Inc. (ESI), for payment. Before reimbursement is granted for non-network pharmacy claims, you must meet an annual TRICARE deductible.
Pharmacy claims must be filed within one year of the date of service. To file a pharmacy claim, obtain and fill out a DD Form 2642 Patient’s Request for Medical Payment. Prescription claims require the following information for each drug:
-
Name of the patient
-
Name, strength, date filled, days supply, quantity dispensed, and price of each drug
-
National Drug Code, if available
-
Prescription number of each drug
-
Name and address of the pharmacy
-
Name and address of the prescribing physician
Mail the claim to:
Express Scripts, Inc.
TRICARE Claims
P.O. Box 66518
St. Louis, MO 63166-6518
Call 1-866-DoD-TRRx (1-866-363-8779) with questions about filing a pharmacy claim.
Back to Top
|
