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Health Care and Pharmacy Claims
Health Care Claims
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 Claims section or from Humana Military’s Claims section. 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 Claims section for additional claims processing information.
Pharmacy Claims
If you have other health insurance (OHI), you will need to submit pharmacy claims to Express Scripts, Inc. (ESI) for payment. 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:
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Name of the patient
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Name, strength, date filled, days supply, quantity dispensed, and price of each drug
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National Drug Code, if available
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Prescription number of each drug
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Name and address of the pharmacy
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Name and address of the prescribing physician
Express Scripts, Inc.
TRICARE Claims
P.O. Box 66518
St. Louis, MO, 63166-6518
If you have additional questions about filing a pharmacy claim, call ESI toll-free at 1-866-DoD-TRRX (1-866-363-8779).
Note: Active duty family members who have prescriptions filled at a non-network pharmacy are using the point of service (POS) option. Active duty service members may be required to pay for the prescriptions in full and will receive a full reimbursement when the claim is filed.
Figure 5.1 Regional Claims Processing Information
| TRICARE North Region |
TRICARE South Region |
TRICARE West Region |
Send claims to:
Health Net Federal Services, Inc.
c/o PGBA, LLC/TRICARE
P.O. Box 870140
Surfside Beach, SC 29587-9740
Check the status of your claim at MyTRICARE or HealthNet Federal Services. |
Send claims to:
TRICARE South Region
Claims Department
P.O. Box 7031
Camden, SC 29020-7031
Check the status of your claim at MyTRICARE or Humana Military's Claims section. |
Send claims to:
West Region Claims
P.O. Box 77028
Madison, WI 53797-7028
Check the status of your claim at TriWest Web site. |
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