Claim
Quick Definition
Request for payment of covered medical services.
Video Explanation
Full Definition
A claim is a formal request for TRICARE to pay for healthcare services you received. In most cases, your provider submits claims directly to TRICARE on your behalf. However, when using non-network providers, you may need to file claims yourself.
Types of claims: • Electronic Claims: Filed by providers through secure systems (fastest processing) • Paper Claims: Manual submission using DD Form 2642 (slower processing)
Who files claims: • Network providers: Always file claims for you • Non-network providers: May file for you or require you to file • Overseas providers: You typically file claims yourself
Claim processing timeline: • Network providers: Usually 30 days • Non-network providers: 30-45 days • Overseas claims: 60-90 days
Filing deadline: Claims must be submitted within one year of the date of service (or one year from the end of the fiscal year for active duty family members).
Track your claims online through the TRICARE beneficiary portal or by contacting your regional contractor.
Related Questions
How does TRICARE work when stationed overseas?
TRICARE Overseas Program (TOP) provides coverage for service members and families stationed outside the US through military facilities and civilian providers.
How do I file a TRICARE claim?
Network providers file claims for you. For non-network providers or overseas care, submit DD Form 2642 with itemized bills to your regional contractor.
What is an Explanation of Benefits (EOB)?
An EOB is a statement from TRICARE showing services billed, amounts TRICARE paid, and any amount you owe. It is not a bill.
How do I check the status of my TRICARE claim?
Check claim status online through your beneficiary portal, call your regional contractor, or review your Explanation of Benefits (EOB).
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