One year filing deadline for TRICARE claims

Published Jan. 29, 2010
By Tyler Patterson and Shari Lopatin

VANDENBERG AIR FORCE BASE, Calif. -- When visiting the doctor, most people might pay their co-pay, then leave.

But what happens if those people visit an out-of-network doctor or have other health insurance? Then they might need to file their own TRICARE claim, which is something their TRICARE network provider is required to do for them.

That is why people should know this important rule: They have one year, from the date of their medical visit or discharge for inpatient services, to file that claim. Once they do that, TRICARE will process your claim and send you any applicable reimbursement, depending on their plan.

To file a TRICARE claim, follow these four steps:

1. Ensure all 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, 1-831-655-8317, or

· By Phone, 1-800-538-9552.

2. Once DEERS is updated, TriWest Healthcare Alliance, which administers TRICARE throughout the West Region, will be notified of any changes. Verify with TriWest the changes have been made before proceeding.

3. Complete and sign the Beneficiary Claim Form, DD Form 2642. If someone injured at work, home, or in an accident, they 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 injured and shipped to a hospital, the hospital files the person's claims. 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 did the treatment, 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
PO Box 77028
Madison, WI 53707-1028

Have Other Health Insurance?

For those with other primary health insurance, other than TRICARE or Medicare, their provider needs to submit a claim to that company first. After the primary insurance company pays its portion, some providers will then file the secondary claim with TRICARE. If they don't, the person is required to send in the claim. Make sure to attach the Explanation of Benefits showing the amount to be paid to the provider.

Registered users of www.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.