Unlocking The Tricare Insurance Billing Process: A Comprehensive Guide

To bill Tricare insurance, you must first determine whether you or your provider will be filing the claim. In most cases, your provider will file your medical claims for you, and you will receive an explanation of benefits detailing what Tricare paid. However, there are times when you will need to file your own claims, such as when you receive care from a non-participating provider or are using Tricare For Life with a Medicare non-participating provider. If you are filing your own claim, you must send your claim form to Tricare as soon as possible after receiving care and within one year of service in the US and its territories or three years in other overseas areas. You can submit your claim online if you are overseas. To file a claim, you will need to fill out the Tricare Claim Form (DD Form 2642) and include a copy of the provider's bill, ensuring it contains the necessary information such as the sponsor's Social Security Number or Department of Defense Benefits Number. Keep a copy of all paperwork for your records and mail your completed claim form to the appropriate claims address. You can also check the status of your claims online or by using the automated self-service tools.

Filling out the TRICARE Claim Form

To bill TRICARE insurance, you will need to fill out the TRICARE Claim Form (DD Form 2642). This form is used for beneficiaries filing their own medical claims to receive reimbursement for TRICARE-covered services. You can download the form online.

When filling out the TRICARE Claim Form, make sure to complete all 12 blocks of the form. Here is some information on what to include in the form:

• Sponsor's Social Security Number (SSN) or Department of Defense Benefits Number (DBN). If you are an eligible former spouse, use your SSN.
• Provider's name and address. If there is more than one provider's name 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.

Additionally, you will need to attach a copy of the provider's itemized bill to the claim form. If you are filing a claim overseas, you may also need to include proof of payment, an invoice, and an explanation of benefits from your other health insurance, if applicable.

Once you have completed the form and gathered all the necessary documentation, mail your completed claim form to the claims address for your claims processor. If you are filing a claim in the U.S. or U.S. territories, you must file your claim within one year of service. In all other overseas areas, you have three years from the date of service to file your claim.

Filing claims online

The next step is to include a copy of the provider's bill. This should include the sponsor's Social Security Number (SSN) or Department of Defense Benefits Number (DBN). If the patient is a former spouse, they should use their SSN. The provider's name and address must be included, and if there is more than one provider, circle the name of the treating provider. The date and place of each service, along with a description of each service or supply, should be listed. Additionally, include the charge for each service and the diagnosis, if not already on the bill.

Once you have completed the form and gathered the necessary documentation, you can submit your claim online if filing from overseas. However, if you are in the US or US territories, you must file your claim within one year of service, and this can be done by mail.

It is important to keep a copy of all paperwork for your records and to note that TRICARE claims processors typically process claims within 30 days.

TRICARE payment options

TRICARE offers a range of payment options for its users. After your first payment, you must pay all your enrollment fees and monthly premiums automatically through one of the following methods:

• Electronic funds transfer
• Debit or credit card
• Online payment

TRICARE also offers various health and dental plans with different payment options. These include TRICARE Reserve Select, TRICARE Retired Reserve, TRICARE Young Adult, and the US Family Health Plan. Each plan has its own specific payment methods, so be sure to choose the plan that best suits your needs and refer to the relevant documentation for detailed information on payment options.

Additionally, TRICARE provides an explanation of benefits (EOB) statement, which is not a bill but an itemized statement detailing the actions taken by TRICARE on your claims. You can access your EOB statements online by logging in or registering on the TRICARE website. This will allow you to track your claims, deductibles, and out-of-pocket expenses.

It is important to note that TRICARE and its contractors will never request personal or financial information over the phone. Be cautious and refrain from sharing sensitive information with unknown individuals to prevent fraud.

Explanation of Benefits Statements

An Explanation of Benefits (EOB) is not a bill. It is an itemized statement that details the action taken by Tricare on your medical claim. It is sent to you each time you receive medical care, or at the end of each month or quarter, depending on your situation. You can receive your EOB online or via mail, depending on your plan, the type of care you received, and where you received it.

An EOB is important because it is your main documentation if you want to file an appeal. For example, if you believe you were charged for something incorrectly, or if you received a bill from a hospital for something that Tricare paid for, your EOB will help you fight the bill collectors.

You should check your EOB to ensure that the name, doctor, and date of service are correct. You should also check:

• Whether you received the services the provider claims to have performed
• Whether you are being billed more than once for the same service
• How much the insurance company paid toward the total bill and whether that matches your plan's benefits
• Whether you have to pay any or all of the bill because you haven't met your deductible
• If the insurance company rejected any of the claims and the reason why

You can get your EOB by signing up to receive your statements online, or by calling your Tricare contractor to request them.

Third-party liability claims

If you are injured in an accident caused by someone else, the Federal Medical Recovery Act allows TRICARE to be reimbursed for its costs of treating you. In such cases, your regional contractor will send you a Statement of Personal Injury-Possible Third Party Liability (DD Form 2527). You must complete and sign this form within 35 calendar days and follow the directions from your regional contractor to return the form to your claims processor.

If you are filing your own claims, you must do so as soon as possible after receiving care. In the U.S. and U.S. territories, claims must be filed within one year of service, and within three years of service in all other overseas areas.

There are special rules for filing claims if you are involved in an accident with possible third-party liability. In these cases, the beneficiary must complete the Possible Third Party Liability form if the health care services received indicate an accident or injury. This form can be submitted by mail or fax.

Frequently asked questions