TRICARE Standard is not available for free, even though it has no enrollment fees. There is a portion of medical costs that are paid such as copayments or deductibles. There are limits and regulations on certain care, whereas some of the care is not covered at all. The appropriate level of care which includes the necessary medical services is what the TRICARE Standard plan helps members to pay toward the total cost of care.
10 Must-Knows about the TRICARE Standard Program:
- Always confirm with your provider about who should be filing the claim. The provider may not be filing for you if one is you are using a non-network provider.
- The DD Form 2642 should be filled correctly. The regional TRICARE services can guide you in filling the form.
- Send the DD Form 2642 to the right address which can be found on a specific regional map. (Click hyperlink to be redirected).
- When you submit your claim that is accurate and complete, this will ensure that your payment will be received timely. Unless you have a waiver, claims should be received within a year of the date of service.
- All claims should be filed separately and not all together. In case there’s a problem with one claim case, it easier to sort so that the payment for that particular case will be the only case that might delay your payment because then it will put them all in ‘pending’ status.
- Other Health Insurance (OHI) should be filed. This is the insurance through a spouse’s plan or any other civilian insurance that you may have. After OHI has made a payment, a claim should be filed with TRICARE. It is not necessary to mention the OHI claim because it may cause TRICARE to deny or delay the payment.
- The information in the DEERS database should be current and this may be confirmed from the DEERS officers or military personnel officer or by calling 800-538-9552.
- When accidents occur, all claims must have a DD Form 2527 which is available through this hyperlink. If the accident was caused by another party and you are hurt, the other party’s insurance is legally bound to pay some or all of the bills, including the hospital ones. You are also advised to file a claim with TRICARE immediately and state the necessary information that another person was involved.
- Make copies of all the claims that have been submitted to have in your own personal records.
- Do not escalate issues. Work with the TRICARE regional contractors first. Claims are only paid when they find you in the TRICARE database. So, make sure to remember to enroll in the DEERS computerized database.
CHARGES FROM THE PROVIDER
Participation by providers in the TRICARE Standards program is voluntary. This means that the provider charges only the authorized allowable amount under TRICARE Standards. A non-participating provider will charge 15% more than the TRICARE allowable standards. It’s up to you to organize with your care provider’s billing staff on how the payment will be made when filing the TRICARE Standard claim. The amount that TRICARE deducts will be paid automatically.