What patient address is included on the claim form TRICARE

Most providers will submit your TRICARE health care claims for you. However, under certain circumstances you can submit your claims to us.

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What to Include in the Claim
Where to Send the Claim
What is the address for TRICARE?
What is a TRICARE patient?
What is the TRICARE East region?
How do I get reimbursed from TRICARE?

You can submit your own TRICARE claims for:

Services from non-network providers received in an office setting.
Durable medical equipment (DME) and supplies (from network or non-network providers).

Your provider must submit claims on your behalf for:

Services performed by a network provider (except DME).
Services performed at a facility (network or non-network), including lab work, radiology and ambulatory surgery.

Learn more on TRICARE's Filing Claims page.

What to Include in the Claim

TRICARE Beneficiary Claim Form DD2642

Complete all boxes on the form.
Be sure to list your medical condition(s) (diagnoses) in Box 8a. If the provider's itemized bill does not include your diagnoses and the information in this box does not describe your medical condition(s) the claim cannot be processed.
Sign the claim form.
Make a copy of everything submitted for your records.
The claim must be submitted within one year of the date you received care.
Only one beneficiary can be listed on each claim form.
To simplify processing, submit separate claims for different providers.

Itemized Provider Bill

The itemized provider bill must be on the provider's letterhead and include:

beneficiary's name,
date of each service,
procedure code or description of each service,
billed amount for each service,
provider's name if services were received from an individual provider (circle provider's name if from a group or clinic with several provider names on the bill), and
provider's address.

Other Health Insurance (OHI) Explanation of Benefits (EOB)

If you have OHI, it is primary to TRICARE (Exceptions: state Medicaid programs, state Victims of Crimes programs, Indian Health Services and TRICARE supplement plans).
Be sure there is a matching EOB for each charge on the provider's bill.
If your OHI denied a charge as a duplicate you will need to include the originally processed EOB for the same service.
If your OHI denies a service as not medically necessary you will need to appeal to your OHI before TRICARE can consider the claim.
See additional information about how TRICARE works with OHI.

Where to Send the Claim

TRICARE Medical Claims

Health Net Federal Services, LLC
c/o PGBA, LLC/TRICARE
PO Box 202112
Florence, SC 29502-2112

TRICARE Pharmacy Claims

TRICARE Pharmacy Claims
Express Scripts
PO Box 52132
Phoenix, AZ 85072

It's important to provide all necessary information on the claim form. The items below are critical to process your claim. Once you complete your claim form, keep a copy of it and all original invoices and receipts.

Box 1: Patient's Name	Enter the patient's last name, first name and middle initial as it appears on the military ID card. Don't use nicknames.
Box 2: Patient's Telephone Number	Enter the patient's daytime evening telephone numbers to include the area code.
Box 3: Patient's Address	Enter the complete address of the patient's place of residence at the time of service. Be sure to use your overseas APO/FPO mailing address. Using a local U.S. address will result in payment problems.
Box 4: Patient's Relationship to Sponsor	Check the box to indicate patient's relationship to sponsor. If "Other" is checked, indicate how related to the sponsor; e.g., former spouse.
Box 5: Patient's Date of Birth	Enter the patient's date of birth.
Box 6: Patient's Sex	Check the box for either male or female patient.
Box 7: Patient's Condition	Check box to indicate if patient's condition is accident related, work related or both. If accident or work related, the patient is required to complete DD Form 2527, Statement of Personal Injury-Possible Third Party Liability.
Box 8a: Describe Condition For which Patient Received Treatment, Supplies, or Medication	Describe patient's condition for which treatment was provided, e.g., broken arm, appendicitis, eye infection. If patient's condition is the result of an injury, report how it happened, e.g., fell on stairs at work, car accident. If you know the diagnosis code, you can include it. If not, please be descriptive.
Box 8b: Was Patient's Care	Check the box to indicate where the care was given.
Box 9: Sponsor's Name	Enter the sponsor's name. If the sponsor is the patient, enter "same."
Box 10: Sponsor's Social Security Number	Enter the Sponsor's Social Security Number (SSN) or Department of Defense Benefits Number (DBN). Former spouses should use their own SSN. The DBN is the 11-digit number on the back of the ID Card.
Box 11: OHI Coverage	Indicate if you are covered by any other health insuranceHealth insurance you have in addition to TRICARE, such as Medicare or an employer-sponsored health insurance. TRICARE supplements don’t qualify as "other health insurance." (OHI) plan to include coverage available though other family members. (Do not report supplemental health insurance.) Learn more about other health insurance.
Box 12: Signature of Patient or Authorized person Certifies correctness of Claim and Authorizes Release of Medical or Other Insurance Information	The patient or other authorized person must sign the claim. If the patient is under 18 years old, either parent may sign unless the services are confidential and then the patient should sign the claim. If the patient is 18 years or older, but cannot sign the claim, the person who signs must be either the legal guardian, or in the absence of a legal guardian, a spouse or parent of the patient. If other than the patient, the signer should print or type his/her name in Box 12a and sign the claim. Attach a statement to the claim giving the signer's full name and address, relationship to the patient and the reason the patient is unable to sign. Include documentation of the signer's appointment as legal guardian, or provide your statement that no legal guardian has been appointed. If a power of attorney has been issued, provide a copy
Box 13: Payment Currency	If this is a claim for care received overseas, indicate if you want payment in the local currency. Note: Payment is available only in some local currencies.

Last Updated 6/6/2022

What is the address for TRICARE?

When you need to file a paper claim for medical, pharmacy or dental services, send the claim to the correct claims filing address to avoid a delay in payment. ... Pharmacy Claims..

What is a TRICARE patient?

TRICARE is the uniformed services health care program for active duty service members (ADSMs), active duty family members (ADFMs), National Guard and Reserve members and their family members, retirees and retiree family members, survivors, and certain former spouses worldwide.

What is the TRICARE East region?

East Region. Louis area), New Hampshire, New Jersey, New York, North Carolina, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas (excluding El Paso area), Vermont, Virginia, West Virginia, and Wisconsin.

How do I get reimbursed from TRICARE?

Medical Claims.

Fill out the TRICARE Claim Form. Download the Patient's Request for Medical Payment (DD Form 2642). ... .

Include a Copy of the Provider's Bill. Attach a readable copy of the provider's bill to the claim form, making sure it contains the following: ... .

Submit the Claim. ... .

Check the Status of Your Claims..

What patient address is included on the claim form TRICARE

What to Include in the Claim

Where to Send the Claim

What is the address for TRICARE?

What is a TRICARE patient?

What is the TRICARE East region?

How do I get reimbursed from TRICARE?

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