An official website of the United States government
A .mil website belongs to an official U.S. Department of Defense organization in the United States.
A lock (lock ) or https:// means you’ve safely connected to the .mil website. Share sensitive information only on official, secure websites.

News | Aug. 20, 2024

TRICARE How-To: Filing Claims and Reimbursements

By TRICARE Communications

Have you ever had to get care while traveling? Or maybe you’ve had to visit a non-network TRICARE-authorized provider who doesn’t “participate.” In these situations—and some others—you might need to file a claim with TRICARE to get reimbursed. 

A medical claim is a paper or electronic form that you submit to TRICARE for reimbursement.

“All TRICARE network providers have agreed to participate on all claims. That means their office will always file claims for you, and TRICARE will pay them directly,” said Jody Donehoo, chief of the TRICARE Customer Support Division at the Defense Health Agency. “But non‑network TRICARE providers can choose not to participate on a case-by-case basis. Just be sure your non‑network provider is TRICARE-authorized—ask them!”

If you’re uncertain about the claims and reimbursements process, here are some common questions and helpful tips.

Q: What does it mean when a non-network provider doesn’t participate on a claim?
A: If your provider chooses not to participate on a particular claim, you may need to pay the provider up front. You’ll then need to file a claim with your TRICARE contractor for reimbursement. 

You should know that non‑network TRICARE-authorized providers are allowed to require payment up front when they see you. However, many providers will wait for payment until after they send you a bill or invoice.

Q: How do I get reimbursed for upfront payments?
A: A reimbursement is the money TRICARE pays back to you if you paid your provider out of pocket. Remember, if you pay up front for services, be sure to get a receipt so you can include it with your claim.

When you get your reimbursement and Explanation of Benefits, you should verify the amount you owed in the “patient responsibility” section of the EOB. If you paid more than this amount to your provider, contact your provider to request a refund of the overpayment. You may need to provide a copy of the EOB.

Q: When do I need to file my own claims?
A: As detailed in the TRICARE Choices in the United States Handbook, you’ll need to file your own claims when you:

  • See nonparticipating providers: If you see a non-network TRICARE-authorized provider who chooses not to participate on your claim, you'll need to file a claim to get reimbursed for your expenses. Check out Filing Claims to get started.
  • Get care overseas: Different TRICARE plans have different rules for getting care when traveling overseas. If you need to file a claim for care you received overseas, you'll file the claim with the TRICARE Overseas contractor, International SOS.

Q: How do I avoid needing to file claims?
A: Follow these tips to avoid filing claims:

  • Get care at a military hospital or clinic: Because military hospitals and clinics don’t operate on a TRICARE claim basis, going to a military hospital or clinic is the best way to avoid filing a TRICARE claim.
  • Use network providers: If you can’t get an appointment at a military hospital or clinic, stick to seeing civilian TRICARE network providers whenever possible. They’ll file claims for you, so you won’t have to worry about paperwork. You’ll just pay your cost-share, if applicable. (It’s also good to note that all hospitals that participate with Medicare must participate with TRICARE.)
  • Get a referral or pre-authorization: Depending on the care you need, you may need a referral, a pre-authorization, or both. These show that you’ve been approved for treatment before going to your appointment. Your primary care provider can give you a referral. You can get a pre-authorization from your TRICARE contractor. This upfront process helps ensure you get the care you need, and that your claims process will go smoothly later.
  • Keep records: Save all your receipts and treatment documentation. Organized records can ease the process of filing claims.

Q: How do I file a medical claim?
A: To file a claim, follow these steps:

  1. Gather documents: Collect all relevant documents, including itemized bills, receipts, and any other paperwork related to medical expenses.
  2. Complete forms: Fill out the appropriate claim form.
  3. Submit documents: Mail the completed claim form and supporting documents to the appropriate claims address, or submit online through your TRICARE regional contractor.
  4. Follow up: After submitting your claim, keep an eye on its status. You can check online by region or call your regional contractor for updates.
For more information, visit Filing Claims, or contact your regional contractor.
 

Would you like the latest TRICARE news sent to you by email? Visit TRICARE Subscriptions, and create your personalized profile to get benefit updates, news, and more.
 

Doctor uses a tablet.

Check the TRICARE Network Provider Directories A...

News
Dec. 11, 2024

If you get care outside of a military hospital or clinic, it’s important to understand your civilian provider...
Read More
Image of person holding cellphone and looking at calendar app. Text reads "TRICARE Open Season 2024: Open Season Ends Soon! Nov. 11 - Dec. 10"

TRICARE Open Season Ends Dec. 10: Your Last Chan...

News
Dec. 05, 2024

Time is running out to review and update your TRICARE health plan for 2025. TRICARE Open Season ends Tuesday,...
Read More
Map highlighting Wisconsin, Missouri, Arkansas, and Indiana. A small portion of Indiana is highlighted in blue (West Region); small portions of Wisconsin, Missouri, and Arkansas are highlighted in green (staying in the East Region).

Reminder: TRICARE Regions Are Changing Jan. 1, 2025

News
Dec. 03, 2024

There will be changes to the TRICARE regions in the U.S. on Jan. 1, 2025. While there will still be two...
Read More
Surgeons wearing scrubs stand around machine in operating room.

DHA Hospitals Honored for Surgical Excellence

News
Nov. 27, 2024

The American College of Surgeons National Surgical Quality Improvement Program has recognized three Defense...
Read More
Man works on a laptop

TRICARE Open Season: Understanding Who’s Eligible

News
Nov. 26, 2024

It’s that time of year again—TRICARE Open Season is here. Open season, which began Nov. 11, runs until Dec...
Read More
Mother and child look at laptop

How To Schedule an Appointment Using the MHS GEN...

News
Nov. 21, 2024

Navigating your healthcare appointments at military hospitals and clinics is convenient with the MHS GENESIS...
Read More
Doctor checks a child's hearing

TRICARE Now Covers Hearing Aids for Children of ...

News
Nov. 20, 2024

TRICARE has recently expanded its hearing aid coverage to include eligible children of retired service...
Read More
Nationally Recognized Leapfrog Hospital Safety Grade A, Fall 2024.

Fifteen Military Hospitals Receive Leapfrog’s Hi...

News
Nov. 15, 2024

The Defense Health Agency announced 15 military hospitals got an “A” rating in Leapfrog Hospital Safety Grade...
Read More

Dec. 11, 2024

Check the TRICARE Network Provider Directories Ahead of 2025

If you get care outside of a military hospital or clinic, it’s important to understand your civilian provider options. TRICARE’s new regional contracts, which begin Jan. 1, 2025, will affect the TRICARE provider networks in the U.S. You’re now able to check the network provider directories for both the East Region and West Region.

Dec. 5, 2024

TRICARE Open Season Ends Dec. 10: Your Last Chance To Update Health Coverage for 2025

Time is running out to review and update your TRICARE health plan for 2025. TRICARE Open Season ends Tuesday, Dec. 10, marking your last day to enroll in a new plan or make changes to your health coverage.

Dec. 3, 2024

Reminder: TRICARE Regions Are Changing Jan. 1, 2025

There will be changes to the TRICARE regions in the U.S. on Jan. 1, 2025. While there will still be two TRICARE regions, six states currently in the East Region will move to the West Region. There are also some zip codes in four of these states that will be exceptions to the region changes.

Nov. 27, 2024

DHA Hospitals Honored for Surgical Excellence

The American College of Surgeons National Surgical Quality Improvement Program has recognized three Defense Health Agency hospitals for their outstanding surgical care.

Nov. 26, 2024

TRICARE Open Season: Understanding Who’s Eligible

It’s that time of year again—TRICARE Open Season is here. Open season, which began Nov. 11, runs until Dec. 10. During this period, most beneficiaries with TRICARE Prime or TRICARE Select can make changes to their health plan for coverage starting Jan. 1, 2025.

Nov. 21, 2024

How To Schedule an Appointment Using the MHS GENESIS Patient Portal

Navigating your healthcare appointments at military hospitals and clinics is convenient with the MHS GENESIS Patient Portal’s scheduling feature.

Nov. 20, 2024

TRICARE Now Covers Hearing Aids for Children of Military Retirees

TRICARE has recently expanded its hearing aid coverage to include eligible children of retired service members. This new coverage results from a new statute. It aims to improve access to life-changing medical technology and help eligible children of retired service members get the hearing aids they need.

Nov. 15, 2024

Fifteen Military Hospitals Receive Leapfrog’s Highest Safety Grade

The Defense Health Agency announced 15 military hospitals got an “A” rating in Leapfrog Hospital Safety Grade fall 2024 assessment. This grade reflects the DHA’s ongoing dedication to transparency and to provide high-quality, safe care to service members and their families.

Nov. 11, 2024

TRICARE Open Season 2024 Begins: Learn if You Need To Take Action

Have you considered changing your family’s TRICARE health plan for 2025? Now is your opportunity: TRICARE Open Season starts Nov. 11 and runs through Dec. 10.

Nov. 7, 2024

Check Out Your 2025 TRICARE Health Plan Costs

With 2025 just around the corner, you may be starting to consider your family’s health needs for next year. There may be changes to your TRICARE health plan costs starting Jan. 1, 2025. Depending on your plan, these costs may include enrollment fees, premiums, cost-shares, and copayments.