One-year filing deadline for Tricare claims

  • Published
  • By By Tyler Patterson and Shari Lopatin
  • TriWest Healthcare Alliance
FALLS CHURCH,Va. --  Many visitors to the doctor probably pay their co-pay and then leave.

But what if the visit is an out-of-network doctor or someone has other health insurance? Those people might need to file their own Tricare claim, something a Tricare network provider is required to do.

That's why people should know this important rule: Individuals have one year from the date of their medical visit or discharge for inpatient services to file that claim. Once doing that, Tricare will process claims and send any applicable reimbursement, depending on one's plan.

To file a Tricare claim, follow these four steps:

1. Ensure your information in the Defense Enrollment Eligibility Reporting System is current. This can be done in several ways:
· In person at a military personnel office or uniformed services ID card-issuing facility;
· Online through the DEERS Web site by visiting www.Tricare.mil/deers;
· By mail by sending the required information to Defense Manpower Data Center Support Office, Attention: COA, 400 Gigling Road, Seaside, CA 93955-6771;
· Via fax at 1-831-655-8317; or
· By phone at 1-800-538-9552.

2. After updating DEERS, TriWest Healthcare Alliance, which administers Tricare throughout the western region, is notified of any changes. Before proceeding, verify the changes with TriWest.

3. Complete and sign the Beneficiary Claim Form, DD Form 2642. Those injured at work, home or in an accident may need to complete the Statement of Personal Injury - Possible Third Party Liability Form, DD Form 2527. Both forms are available by clicking on Find a Form at www.triwest.com. Please note if you were injured and go to a hospital, hospitals file your claims for you, yet some emergency-room doctors, urgent-care doctors, radiologists or ambulance companies may not file claims.

4. Attach a copy of the doctor's bill to the claim form (DD Form 2642). Make sure the billing information includes the name and address of the person who treated you, the date and place of each service, a description of each service, the charge for each service, and the diagnosis. If the diagnosis is not on the bill, remember to complete "Block 8a" on DD Form 2642. After that, mail the information within the one-year deadline to:
West Region Claims
P.O. Box 77028
Madison, WI 53707-1028

If you have primary health insurance other than Tricare or Medicare, your provider needs to submit your claim to that company first. After your primary insurance company pays its portion, some providers will then file the secondary claim with Tricare. If they don't, you will send in the claim. Make sure to attach your explanation of benefits showing the amount to be paid to the provider.

Registered users of Triwest.com receive QuickAlert notifications when their claims status changes. You can also learn how to Go Green with statements on www.triwest.com/gogreen. For more information and exceptions to the one-year filing deadline for claims, visit www.triwest.com/beneficiary/claims.aspx.