One year filing deadline for TRICARE claims

By Tyler Patterson and Shari Lopatin: TriWest Healthcare Alliance

PHOENIX — When you visit the doctor, you probably pay your co-pay, then leave.

But what if you visit an out-of-network doctor or have other health insurance? You might need to file your own TRICARE claim, something your TRICARE network provider is required to do for you.

That’s why you should know this important rule: You have one year, from the date of your medical visit or discharge for inpatient services, to file that claim. Once you do that, TRICARE will process your claim and send you any applicable reimbursement, depending on your plan.

To file your own TRICARE claim, follow these steps:

• Ensure your information in the Defense Enrollment Eligibility Reporting System (DEERS) is current. This can be done in several ways:

• In person at a military personnel office or uniformed services ID card-issuing facility

• Online through the DEERS Web site by visiting www.tricare.mil/deers

• By mail by sending the required information to Defense Manpower Data Center Support Office, Attention: COA, 400 Gigling Road, Seaside, CA 93955-6771

• Via Fax, 1-831-655-8317, or

• By Phone, 1-800-538-9552.

Once you update DEERS, TriWest Healthcare Alliance, which administers TRICARE throughout the West Region, will be notified of any changes. Verify with TriWest the changes have been made before proceeding.

Complete and sign the Beneficiary Claim Form, DD Form 2642. If you were injured at work, home, or in an accident, you may need to complete the Statement of Personal Injury — Possible Third Party Liability Form, DD Form 2527. Both forms are available by clicking on “Find a Form” at www.triwest.com. Please note if you were injured and go to a hospital, hospitals file your claims for you. Yet some emergency room doctors, urgent care doctors, radiologists or ambulance companies may not file claims.

Attach a copy of the doctor’s bill to the claim form (DD Form 2642). Make sure the billing information includes the name and address of the person who treated you, the date and place of each service, a description of each service, the charge for each service, and the diagnosis. If the diagnosis is not on the bill, remember to complete “Block 8a” on DD Form 2642. After that, mail the information within the one-year deadline to: West Region Claims, PO Box 77028, Madison, WI 53707-1028.

If you have primary health insurance, other than TRICARE or Medicare, your provider needs to submit your claim to that company first. After your primary insurance company pays its portion, some providers will then file the secondary claim with TRICARE. If they don’t, you will send in the claim. Make sure to attach your Explanation of Benefits showing the amount to be paid to the provider.

Registered users of triwest.com receive QuickAlert notifications when their claims status changes. You can also learn how to Go Green with statements on www.triwest.com/gogreen. For more information and exceptions to the one-year filing deadline for claims, visit: www.triwest.com/beneficiary/claims.aspx