How to File a TRICARE Claim: 2026 Guide
*Disclaimer: TRICARE.com is an independent reference site and is not affiliated with the official TRICARE program or the Department of Defense. For official policy and government information, visit TRICARE.mil.*
## Quick answer In most cases, your doctor will file TRICARE claims for you. However, you must file a claim yourself if you receive care from a non-participating provider, receive care overseas, or use a pharmacy that is not in the Express Scripts network. To do this, you typically submit DD Form 2642 along with itemized receipts to your specific regional contractor (Humana Military or TriWest).
In detail
### When You Must File a Claim If you are using **TRICARE Prime**, your Primary Care Manager (PCM) and the military hospital system handle all paperwork. However, for **TRICARE Select**, **TRICARE Reserve Select**, or **TRICARE For Life**, you may encounter situations where the provider does not bill TRICARE directly.
You are responsible for filing the claim if: * You see a non-participating, non-network provider. * You receive care outside of the United States (Overseas). * You use a retail pharmacy that is not part of the Express Scripts network. * You have Other Health Insurance (OHI) that pays first, and the provider does not bill TRICARE for the remaining balance.
### Steps to File a Medical Claim (2026 Process) 1. **Download DD Form 2642:** This is the "Patient's Request for Medical Payment." 2. **Attach Itemized Receipts:** You cannot send a simple credit card receipt. The bill must include the provider’s name/address, the date of service, the specific CPT codes (procedure codes), the ICD-10 codes (diagnosis codes), and the charge for each service. 3. **Proof of Other Insurance:** If you have OHI, you must include the Explanation of Benefits (EOB) from your primary insurer showing what they paid. 4. **Submit to the Correct Contractor:** * **TRICARE East (Humana Military):** Submit via the Humana Military portal or mail to their claims address. * **TRICARE West (TriWest Healthcare Alliance):** Submit via the TriWest portal or mail. (Note: TriWest assumed full West Region operations on Jan 1, 2025). * **TRICARE Overseas (International SOS):** Submit via the TOP portal or the specific regional mailing address for Eurasia-Africa, Latin America, or Pacific.
### Time Limits for Claims * **United States/U.S. Territories:** Claims must be filed within **one year** of the date of service or the date of inpatient discharge. * **Overseas:** Claims must be filed within **three years** of the date of service.
### Pharmacy Claims Pharmacy claims are handled separately by **Express Scripts**. If you pay out-of-pocket at a non-network pharmacy, you must submit a claim for reimbursement. For **2026 rates**, remember that you will likely pay the full price upfront and be reimbursed only the TRICARE-allowed amount, minus the applicable non-network deductible and copays.
## Who this applies to * **TRICARE Select Beneficiaries:** Frequently see non-network providers and may need to file their own paperwork. * **TRICARE For Life (TFL) Users:** Usually, Medicare forsyth bills TRICARE automatically. However, if care is received overseas where Medicare doesn't pay, the beneficiary must file with International SOS. * **Active Duty Guard/Reserve:** When using TRICARE Reserve Select (TRS) and visiting non-network clinicians. * **Members with OHI:** If the provider refuses to coordinate with TRICARE after billing the primary insurance.
Common scenarios
**Scenario 1: The Non-Network Specialist** Jane is on TRICARE Select in Virginia (East Region). She visits a specialist who does not participate in TRICARE. She pays $300 out-of-pocket. She submits DD Form 2642 to **Humana Military** with the itemized bill. Because she has already met her 2026 deductible, TRICARE calculates the "allowable charge" as $250. Jane is reimbursed a portion of that $250, while she remains responsible for the difference between the $300 charged and the TRICARE allowable rate.
**Scenario 2: Emergency Care Overseas** Mark, a retiree living in Italy, goes to a local ER. He pays €500 ($540 USD) upfront. He must submit his claim to **International SOS** with a translated itemized receipt. He will be reimbursed based on the 2026 TRICARE Overseas cost-shares for retirees.
**Scenario 3: Out-of-Network Pharmacy** Sarah is traveling and uses a non-network pharmacy for an urgent prescription. She pays $120. She files a claim with **Express Scripts**. Because it was a non-network pharmacy, her 2026 reimbursement is limited to the TRICARE-allowed price minus the non-network copay (often 50% or more).
## Related terms * **DD Form 2642:** The primary form used by beneficiaries to request reimbursement for medical care. * **Explanation of Benefits (EOB):** A statement sent by TRICARE after a claim is processed explaining what was covered and what you owe. * **Allowable Charge:** The maximum amount TRICARE will pay for a specific medical service. * **Other Health Insurance (OHI):** Any non-TRICARE health insurance you have through an employer or private policy. * **Point of Service (POS) Option:** An option for Prime members to see non-network providers without a referral, usually requiring the member to file their own claim.
## Sources * **TRICARE.mil Claims Overview:** https://www.tricare.mil/claims * **Humana Military (East):** https://www.humanamilitary.com/beneficiary/claims * **TriWest Healthcare Alliance (West):** https://www.triwest.com/en/beneficiary/ * **Express Scripts Pharmacy:** https://militaryrx.express-scripts.com/claims