In most cases, your provider will file your medical claims for you and you'll receive an explanation of benefits detailing what was paid. Sometimes, you'll need to file your own claims:
- When traveling
- If you get care from a non-participating provider
- If you're using TRICARE For Life and you see a Medicare nonparticipating provider
If you do, send your claim form to TRICARE as soon as possible after you get care.
- In the U.S. and U.S. territories, claims must be filed within one year of service.
- In all other overseas areas, claims must be filed within three years of service.
The sooner your claim and other paperwork are received, the sooner you or your provider will be paid. Most claims are processed within 30 days. Please check with your claims processor for more information.
- You'll be reimbursed for TRICARE-covered services at the TRICARE allowable amount.
- This amount won't include any copayments, cost shares or deductibles.
- There are special rules for filing claims if you're involved in an accident with possible third-party liability.
- If you need assistance at any time or if your claim is denied, contact your regional contractor.
Claims for Same-Sex Spouses
Once your spouse shows as eligible for benefits in the Defense Enrollment Eligibility Reporting System (DEERS), he or she can file claims for care received:
- On or after June 26, 2013—if married before June 26, 2013, or
- Back to the date of eligibility in DEERS—if married after June 26, 2013.