You may be wondering how to file Tricare claims if you have Tricare insurance. As defined by program guidelines, your Tricare provider will file your medical claims on your behalf in most instances. However, there are circumstances in which you will need to file your own claims. Before you can do so, you will need to know when this occurs and how to go about doing so.
Once you have obtained and filled out a Tricare claim form, you will need to submit it. Depending on where you are, you can submit your claim either by mail or online. Then, you can check the status of your claim in your region. It is essential that you know that not every claim submitted will be approved, and that there are many reasons for Tricare to deny your claim. However, you can file an appeal if you believe it was wrongly denied.
When will I need to file a TRICARE claim?
Before you search for a Tricare claims phone number, you need to know which circumstances require you to file a claim.
According to Tricare guidelines, you will need to file your own claims if you fall into one of the below categories:
- You are traveling.
- You receive a health care service from a non-participating provider.
- You have a Tricare for Life plan, and you see a Medicare, non-participating provider.
If you do not fall into one of the above categories, then you will not need to file claims with Tricare.
How soon do I need to submit a TRICARE claim?
If you need to submit a Tricare claim, then you must do so as soon as possible after you receive a health care service. If you are in the U.S. or a U.S. territory, then you must file claims within one year from the date of service. If you are overseas, you must do so within three years from the date of service.
For more information on how to file Tricare claims, download our comprehensive guide.
What do I need to include in my TRICARE claim?
You are ready to submit a Tricare for life claim or another qualifying claim, now that you know that doing so is necessary. To do so, you must be sure to include the mandatory information.
First, you will need to obtain a copy of the request for medical payment form. You can download and print a copy of the form online on the Tricare website. Once you complete the form, you must sign it.
Next, you must attach a readable copy of the provider’s bill to your signed payment form. Information that must be included includes the provider’s name and address, and the date, place, description, diagnosis, and amount charged for each service.
Before you submit a claim, you must make and save a copy of all paperwork for your records. If you need help at any time with gathering the necessary information, you can call your regional Tricare contractor.
How to Submit a TRICARE Claim
You are now ready to submit a Tricare claim now that you gathered the necessary information. To do so, you must mail the completed claim form to the claims address in the region in which you reside. You must submit a claim’s form by mail unless you are filing a claim overseas. Then, you can submit your claim online through the Tricare website.
Find out everything that you need to know about how to submit a Tricare claim by downloading our free guide.
Note: Tricare has special rules for filing claims if you are involved in an accident with possible third-party liability.
How can I check a TRICARE claim status?
You can check a Tricare claim status online. However, you will need to register through the Tricare website for the region in which you reside.
Once you register, you can also look up your out-of-pocket expenses and your deductibles. You can also update any other health insurance you have in addition to Tricare, such as Medicare, and view a detailed explanation of your benefits.
How long does it take for TRICARE to process my claim?
The length that it takes to receive your Tricare reimbursement depends on when your paperwork is received. Therefore, the sooner that you submit a claim, the sooner you or your provider will be paid. Most Tricare claims are processed within 30 days.
Once your Tricare reimbursement form and paperwork are approved, you will be reimbursed for Tricare-covered services at the Tricare allowed amount. It is crucial that you know that deductibles, cost shares are copayments are not eligible for reimbursement.
What can I do if my TRICARE claim is denied?
You may be wondering what to do if your Tricare claim is denied after you properly submit a claim.
As defined by Tricare, a claim may be denied for many reasons. However, a claim is typically denied due to simple errors, such as incorrect filing, that occurs either when you or your provider submits a Tricare claim. If this occurs, then you must correct the mistake then resubmit it to the claim’s processor in your region.
If your Tricare claim is denied and you believe it had been done so inappropriately, either in part or in whole, you or another party may file an appeal. To do so, you must visit the Tricare website. From there, you will be walked through the steps to filing an appeal for your Tricare claim.
Also, if your claim is unpaid or denied, you must contact your regions claims processor for more information. Therefore, before you submit a Tricare claim, it is important that you follow all directions as listed on the claim’s form. By doing so, you can better prevent errors or delays that may appear on your Tricare claim.