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Processing Claims for Out-of-Region Care
If you provide health care services to a TRICARE beneficiary who resides in or is enrolled in a different region, the beneficiary will pay the applicable cost-share, and you will submit reports and claims information to the region based on the TRICARE beneficiary’s enrollment address, not the region in which he or she received care. If you have a claim issue or question regarding a TRICARE patient who normally receives care in another TRICARE region, call the appropriate number listed below for assistance.
North Region
1-877-TRICARE (1-877-874-2273)
The North Region includes Connecticut, Delaware, the District of Columbia, Illinois, Indiana, Iowa (Rock Island Arsenal area only), Kentucky, Maine, Maryland, Massachusetts, Michigan, Missouri (St. Louis area only), New Hampshire, New Jersey, New York, North Carolina, Ohio, Pennsylvania, Rhode Island, Tennessee (Fort Campbell area only), Vermont, Virginia, West Virginia, and Wisconsin
West Region
1-888-TRIWEST (1-888-874-9378)
The West Region includes Alaska, Arizona, California, Colorado, Hawaii, Idaho, Iowa (excluding the Rock Island Arsenal area), Kansas, Minnesota, Missouri (excluding the St. Louis area), Montana, Nebraska, Nevada, New Mexico, North Dakota, Oregon, South Dakota, Texas (the southwestern corner only, including El Paso), Utah, Washington, and Wyoming
Claims for Beneficiaries Assigned to US Family Health Plan Designated Providers
Designated providers are facilities specifically contracted with the Department of Defense to provide care to beneficiaries enrolled in the US Family Health Plan (USFHP). The USFHP is offered in six geographic regions in the United States. Although it provides the TRICARE Prime benefit, the USFHP is a separately funded program different from the TRICARE program administered by Humana Military. The designated provider is responsible for all medical care for a USFHP enrollee, including pharmacy services, primary care, and specialty care.
If you provide care to a USFHP enrollee outside the network or in an emergency situation, claims must be filed with the appropriate designated provider at one of the addresses listed in Figure 8.3. Do not file USFHP claims with Humana Military.
Figure 8.3 USFHP Designated Providers
Martin’s Point Health Care
P.O. Box 11410
Portland, ME 04104-7410 |
Brighton Marine Health Center
P.O. Box 9195
Watertown, MA 02471-9195 |
St. Vincent Catholic Medical Centers of New York
US Family Health Plan at SVCMC
P.O. Box 830745
Birmingham, AL 35283-0745 |
Johns Hopkins Medical Services Corporation
6704 Curtis Court
Glen Burnie, MD 21060 |
CHRISTUS Health
US Family Health Plan
Attn: Claims
P.O. Box 924708
Houston, TX 77292-4708 |
Pacific Medical Clinics
1200 12th Avenue South, Quarters 8 & 9
Seattle, WA 98144-2790 |
For more information about the USFHP, visit the US Family Health Plan Web site.
TRICARE Overseas/Foreign Claims
Wisconsin Physicians Service (WPS) is the claims processor for all overseas claims (except claims for ADSMs with a Puerto Rico address). If filing a claim for a beneficiary who lives in or is enrolled in one of the overseas regions, submit it to one of the addresses listed in Figure 8.4.
Figure 8.4 TRICARE Overseas Claims Contact Information
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TRICARE Europe
(Europe, Africa,
Middle East)
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Wisconsin Physicians Service
P.O. Box 8976
Madison, WI 53708-8976
Phone: 1-608-301-2310 |
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TRICARE
Latin America
and Canada
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Wisconsin Physicians Service
P.O. Box 7985
Madison, WI 53707-7985
Phone: 1-608-301-2311 |
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TRICARE Pacific
(Western Pacific,
Japan, Guam)
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Wisconsin Physicians Service
P.O. Box 7985
Madison, WI 53707-7985
Phone: 1-608-301-2310/2311 |
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Puerto Rico and
Virgin Islands
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Wisconsin Physicians Service
P.O. Box 7985
Madison, WI 53707-7985
Phone: 1-608-301-2310/2311 |
Note: ADSM claims with a Puerto Rico address should be forwarded to PGBA. You may contact PGBA in one of the following ways:
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Phone
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1-800-403-3950 |
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Fax
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1-803-713-0354 |
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Mail
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PGBA South Region
Claims Department
P.O. Box 7031
Camden, SC 29020-7031 |
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Web site
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myTRICARE |
ADFM claims or TRICARE Standard claims with an overseas address should be sent directly to WPS, the overseas claims processor. National Guard and Reserve members on orders of 30 days or less who have claims with an overseas address should also be sent to WPS. If the National Guard and Reserve member can provide a copy of his or her orders and the provider submits a copy of the orders with the claim, the claim processing will be expedited. The orders are important because they verify the member’s eligibility for TRICARE benefits.
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