TRICARE East Region Updates
Resource spotlight: Get smart with claims
June 30, 2026
TRICARE East has tools to help answer your claims questions. Whether you want to submit a claim on your own or have questions about an explanation of benefits, we have resources to help you. Check out the list of topics below to find answers to your questions.
Claims process
Q: What happens when a provider makes a claim after an in-person or virtual visit or another type of medical care?
A: Here’s the life cycle of a claim:
#1: The provider verifies your eligibility and benefits. They do this before your appointment or at check-in.
#2: The provider or their office staff assign standardized medical codes to your diagnosis and the care you received.
#3: The provider’s staff enters the codes into a standard form and sends to TRICARE East for processing.
#4: TRICARE East reviews and evaluates the claim to confirm the service is and covered under the beneficiary’s plan and benefits. They also manage the financial side, applying a or , when applicable.
#5: After processing your claim, TRICARE East moves it to reimbursement and billing. TRICARE East sends the payment directly to the provider and issues an explanation of benefits to the beneficiary. If the payment does not cover the full cost, the provider will send a bill to the patient for the balance. The patient will owe this directly to the provider.
#6: If TRICARE East denies the claim, the provider will correct the errors or provide documentation and re-file the claim. If the claim was denied due to something other than clerical errors, the provider or beneficiary can file an .
If you want more details about the life cycle of a claim, check out this comprehensive Frequently Asked Questions (FAQ). Think of it as “Claims 101.”
Claim processing
Q: Who’s responsible for submitting claims?
A: Most times, your healthcare provider will submit claims to TRICARE East.
Q: What’s a specialty claim?
A: These include durable medical equipment, breastfeeding supplies, banked donor milk, and pharmacy claims. Visit the TRICARE East claims page for details.
Claim status
Q: How do I find the status of a claim?
A: Use beneficiary self-service and the mobile app for iPhone or Android to view a status of a claim. See the beneficiary self-service guide and the TRICARE East mobile app FAQ, for more information.
Processing time
Q: What is a typical claim processing time?
A: Claims processing may take up to 90 days from the date TRICARE East receives it.
Appeals
Q: What do I do if I receive a denial?
A: If you disagree with a decision made about your benefits and it involves an appealable denial, you have the right to submit an appeal. See the instructions on your explanation of benefits for specific guidance on how to begin the appeals process. For your convenience, TRICARE East offers an online Appeal self-service tool, which allows you to submit and track your appeal electronically.
Charges and fees
Q: What is the cost-share?
This is the percentage of the total cost of a covered healthcare service that a beneficiary is required to pay. This applies to beneficiaries enrolled in all TRICARE plans, except active duty service members.
A: What is the point-of-service option?
Point-of-service fees apply if you are a TRICARE Prime beneficiary and you receive nonemergency care from a provider without a from your primary care manager. These fees apply when you obtain preventive care, such as a colonoscopy or Pap test, from a non-network specialist. This doesn’t apply to ADSMs. See these top tips for avoiding point-of-service fees.
Find out more about claims and EOBs.
Updates to TRICARE Coverage of Cervical Cancer Screening
April 15, 2025
Screening tests are the most accurate method to prevent cancer. TRICARE updated its coverage policy for cervical cancer screening to reflect the latest clinical practice guidelines.
Pap tests
TRICARE covers a Pap test every three years for women ages 21 to 65. Women younger than 21 shouldn’t get a cervical cancer screening. Your doctor should also perform a pelvic examination when you get a Pap test.
HPV DNA testing*
TRICARE also covers primary HPV DNA testing:
- Every five years for women ages 30 to 65
- With FDA-cleared self-collection tests
*You must get this testing at the same time you get a Pap test.
Co-testing
TRICARE covers co-testing every five years for women ages 30 to 65. Co-testing uses both a Pap test and an HPV DNA test to check for high-risk HPV and changes in cervical cells.
For more details, visit Cervical Screenings.
Update on TRICARE Claims Payments
April 17, 2025
We want to inform you of a recently identified issue involving the incorrect processing of certain claims.
Due to a system error, some network provider claims were incorrectly processed as if they were from non-network providers, causing incorrect payments.
We are in the process of adjusting the affected claims for proper payment. We appreciate your patience and understanding as we work through this as quickly as possible. Once claims have been corrected, updated Explanation of Benefits will be sent.
Ensure Your Provider Accepts TRICARE
November 26, 2024
It is important for beneficiaries to use a TRICARE provider who accepts assignment on claims and will accept TRICARE reimbursement in full. Use the find care tool to locate a TRICARE provider.
Help ensure your provider accepts TRICARE with the below tips:
TRICARE certified providers who accept the TRICARE-allowed amount accept this as payment in full and will only collect copayments, cost-shares and/or deductibles. TRICARE certified providers who choose not to accept assignment on their claim are allowed to bill the beneficiary up to 115% above the TRICARE .
Utilize the Network Provider locator to find a provider who accepts TRICARE payment in full; Network providers are required to accept assignment on their claims and accept TRICARE allowable as payment in full.
Inquire if your provider if accepts assignment or accepts TRICARE payment in full at the time of the visit.
Last Updated 7/1/2026