Medical Claims

Reading Your Medical Explanation of Benefits

A TRICARE explanation of benefits isn’t a bill. It’s a summary of the services and items you received. It tells you how much your provider billed, the approved amount TRICARE paid, and how much you may have to pay to the provider.

• Your TRICARE contractor creates an EOB for each of your claims.
• You may get one EOB statement detailing all the claims you had in the past month or quarter. This is called a summary EOB.
• You should keep your EOB statements with your health insurance records.

If you live in the East Region or West Region

You’ll get all your medical EOBs online. You must create an account on your regional contractor’s beneficiary portal to view your EOBs.

• East Region Beneficiary Portal
• West Region Beneficiary Portal

Would you like to get paper copies? Call your contractor to opt in to paper EOBs. You’ll get monthly summary EOBs instead of a separate EOB for each claim. If you didn’t get any care during that month, you won’t get a summary EOB.

You can change your preference at any time by calling your regional contractor or logging in to their portal.

Important: If you don’t create an account on your regional contractor’s beneficiary portal, you won’t get any medical EOBs unless you request paper summary EOBs.

If you live overseas

You’ll get all your medical EOBs online if you have an account on the contractor’s secure claims portal and request to go paperless. If you don’t have an account and submit a request to go paperless, you’ll get paper EOBs each time a claim is processed.

• Overseas Region Secure Claims Portal

You can change your preference at any time by calling the contractor or logging in to their portal.

If you have TRICARE For Life

You’ll get paper copies of your EOBs. You’ll get monthly summary EOBs, instead of a separate EOB for each claim. (Note: If you have claims without any beneficiary liability – meaning you don’t owe anything – you’ll get these EOBs once every 90 days.)

Want to go paperless? Create an account with the TRICARE For Life contractor’s beneficiary portal and update your mailing option. Instead of getting monthly EOBs, you’ll get an EOB when your claim has processed.

• TRICARE For Life Benefits Administration Portal

You can change your preference at any time by calling the contractor or logging in to their portal.

Medical Claims Addresses

• For care received in the U.S. or U.S. territories, send your claims to the claims address for the region where you live.
• For medical care received in all other overseas areas, send your claims to the claims address where the care was received. You may also be able to file overseas claims online.

Filing and Checking Claims Status

Follow the steps below to file and check the status of your claims.

Tips:

• Keep a copy of all paperwork for your records.
• If you need help, call your regional contractor.

Are you overseas? If yes, then you can file your claims online. 

Step 1: Fill out the TRICARE claim form

• Download the Patient’s Request for Medical Payment (DD Form 2642).
• Fill out all relevant blocks of the form completely.
• Sign the form.

Step 2: Include a copy of the provider’s bill

Attach a readable copy of the provider’s bill to the claim form. Make sure it includes the following:

• Sponsor’s Social Security number or DOD Benefits Number. (Eligible former spouses should use their own SSN or DBN.)
• Provider’s name and address. (If more than one provider’s name is on the bill, circle the name of the person who treated you.)
• Date and place of each service
• Description of each service or supply furnished
• Charge for each service
• Diagnosis. (If the diagnosis isn’t on the bill, be sure to fill out section 8a on the claim form.)

Note: You must send proof of payment with all overseas claims, including claims for care received when traveling overseas.

Step 3: Submit the claim

• Mail your completed claim form to the claims address for your claims processor.
• If filing a claim overseas, you can submit your claim online.

Step 4: Check the status of your claims

To keep track of your claims online, you’ll need to register on your claim processor’s site:

• East Region
• West Region
• Overseas Region
• TRICARE For Life (U.S. and U.S. territories only)

Once registered, you can also:

• Look up your deductibles and out-of-pocket expenses.
• Update your other health insurance information.
• View your explanations of benefits.

Filing Claims Overseas

If you need to file a claim for care you received overseas, you’ll file the claim with the overseas claims processor using the claims address for the area where you got the care.

Or, you can file your claims online. Watch International SOS’ video tutorials to help guide you through the process.

You must send proof of payment with all overseas claims, including claims for care received when traveling overseas.

Did you pay your provider directly? Write the amount paid at the top of the TRICARE claim form, TRICARE DoD/CHAMPUS Medical Claim Patient’s Request for Medical Payment form (DD Form 2642). Also include the following:

• An itemized bill or invoice (a balance due statement isn’t acceptable)
• Diagnosis describing why the medical care is needed
• An explanation of benefits from your other health insurance, such as travel insurance or an employer-sponsored health insurance (if applicable). Supplemental insurance plans don’t qualify as OHI.

Send any of the following items along with the provider’s invoice or itemized bill as proof of payment:

• Copy of the check showing the service provider’s name in the “pay to the order of” field and signed by the patient or sponsor
• Credit card receipt
• Electronic funds transfer receipt
• Bank statement documenting the dispersal of funds with provider name (matching the claim submission) or cash withdrawal equal to or greater than the paid amount
• Receipt, itemized bill, or statement by provider’s office stamped PAID
• Invoice for pharmaceuticals dispensed on an outpatient basis with a list of prescribed drugs

Note: Due to Turkish law, an invoice is an acceptable proof of payment when the claim is for care rendered by a provider in Turkey.

You may need to complete additional attestations for your claim to process.

Are you bundling more than one claim on a single claim form? You must submit a proof of payment for each service. We’ll review each individual claim separately. We’ll return any items that don’t have proof of payment for further documentation.

Do you have questions about proof of payment, submitting claims, or the status of a claim you’ve already submitted? You can email tricareoverseas@top.internationalsos.com or call your TRICARE Overseas Regional Call Center.

Tips for Filing Claims

Claims may be delayed or denied because the claim form wasn’t filled out correctly or all the information wasn’t provided. Here are some tips to help you file your claims correctly:

Denied Claims

A claim may be denied for several reasons. Many times, it's a simple error that you (if you submitted the claim) or your provider made when submitting the claim.

• If your claim is unpaid or denied, contact your claims processor. See the right side of page for contact information.
• If your claim was denied because of incorrect filing, correct the error and resubmit the claim to your claims processor.
• If you believe your claim was inappropriately denied, in whole or in part, you or another appropriate party may file an appeal.

For help at any time, contact your claims processor.