FALLS CHURCH, Va. –
Are you getting ready for a doctor’s visit? One of the best ways you can prepare is by understanding your health care costs and if you need to pay anything out of pocket. When you see a
TRICARE network provider, the provider will submit the claim on your behalf. But in some cases, like when you see a
non-network provider, you may have to pay for health care services up front and file your own claim to get reimbursed. It’s important to know when you need to
file a claim and how to do so.
When should I file a medical claim?
A claim is a request for payment from TRICARE that goes to your
TRICARE contractor after you get a covered health care service. What determines whether or not you need to submit one is your
TRICARE plan and provider. As a rule of thumb, you should expect to file your own claims if:
If you’re unsure about how your claims will be filed, check with your provider to find out if you need to submit a claim after receiving care. As stated in the
TRICARE Choices in the United States Handbook, “A provider must be TRICARE-authorized for TRICARE to pay any part of your claim.” If you have both Medicare and TRICARE, your claim will go to a Medicare contractor. You don’t need to file claims when using the
US Family Health Plan.
How do I file a medical claim?
This process depends on where you received care. If you’re filing a stateside claim, submit your completed
medical claim form (
DD Form 2642) and supporting information to your
TRICARE contractor. In the U.S. and U.S. territories, you must file claims within one year of service or the date of inpatient discharge.
For overseas claims, submit the claim form and
proof of payment to the
TOP claims processor. You must file overseas claims within three years of service or the date of inpatient discharge. The simplest way to file overseas claims is to do it online. You just need to log in to the
beneficiary secure claims portal. If you need help, there are
video tutorials to help guide you. If you’re enrolled in or live in the U.S. and receive care while traveling overseas, you’ll file your claim and proof of payment to the TOP claims processor.
Do you have TRICARE For Life? In most cases in the U.S. and U.S. territories, your provider files your health care claims with Medicare. After paying its portion, Medicare sends the claim to the
TFL contractor to process, unless you have OHI. If you have OHI in addition to Medicare and TFL, you’ll need to file a claim with TRICARE for reimbursement of any remaining balance. As outlined in the
TRICARE For Life Handbook, you’ll need to submit
DD Form 2642, a copy of your provider’s bill, the corresponding
Medicare Summary Notice, and OHI explanation of benefits to the TFL contractor.
For care received overseas, Medicare and the TFL contractor don’t process your claims. You should
file your claim along with proof of payment with the TOP claims processor. Refer to the handbook for more details about filing TFL claims for care received overseas.
How do I check the status of my medical claim?
If you want to check the status of your medical claim, you can do so online. You must first register on your
claims processor’s website. Once you do that, you’ll be able to see where your claim is in the process. You can also view your
explanation of benefits, out-of-pocket expenses, and more after registering online. Keep in mind, most claims are processed within 30 days.
For more on how to file medical claims, visit
Filing Claims. There, you can also learn about other types of claims, including
pharmacy and
dental. And be sure to listen to the “Get to Know TRICARE” podcast episode,
Help! How to File Claims, for more helpful claim filing tips.