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 region-specific number for assistance.
        

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. 
          

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.

Designated providers are facilities that have contracts with the Department of Defense (DoD) 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 a TRICARE Primelike benefit, the USFHP is a separately funded program that is distinct 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 of the network or in an emergency situation, file claims with the appropriate designated provider at one of the addresses listed in Figure 8.3. Do not file USFHP claims with Humana Military. For more information about the USFHP, visit the US Family Health Plan web site.

International SOS Assistance, Inc. (International SOS), administers the TRICARE program overseas and handles claims processing for all overseas claims. If filing a claim for an ADSM who is enrolled in a TRICARE Overseas Program (TOP) option (TOP Prime, TOP Prime Remote, or TOP Standard), submit it to the address listed in Figure 8.4. If filing a claim for a non-ADSM who is enrolled in a TOP option submit it to one of the addresses listed in Figure 8.5.

Note: This includes TFL claims for medical care received outside the United States and its territories.
Overseas claims for National Guard and Reserve members on orders of 30 days or less must also be sent to International SOS. To expedite claims, the provider should submit a copy of the member’s orders with the claim. The orders verify the member’s eligibility for TRICARE benefits.

For more information on filing claims for TOP beneficiaries, visit the TRICARE Overseas web site, or call International SOS at 1-877-451-8659.