Submitting Claims and Checking Status

Health Net Federal Services can accept claims for dates of service prior to Jan. 1, 2025. We must receive these by April 30, 2025. 

Most providers will submit your TRICARE health care claims for you. However, under certain circumstances you can submit your claims to us.

You can submit your own TRICARE claims for:

• Services from non-network providers received in an office setting.
• Durable medical equipment (DME) and supplies (from network or non-network providers).

Your provider must submit claims on your behalf for:

• Services performed by a network provider (except DME).
• Services performed at a facility (network or non-network), including lab work, radiology and ambulatory surgery.

Learn more on TRICARE's Filing Claims page. 

What to Include in the Claim

TRICARE Beneficiary Claim Form DD2642

• Complete all boxes on the form.
• Be sure to list your medical condition(s) (diagnoses) in Box 8a. If the provider's itemized bill does not include your diagnoses and the information in this box does not describe your medical condition(s) the claim cannot be processed.
• Sign the claim form.
• Make a copy of everything submitted for your records.
• The claim must be submitted within one year of the date you received care.
• Only one beneficiary can be listed on each claim form.
• To simplify processing, submit separate claims for different providers.

Itemized Provider Bill 

The itemized provider bill must be on the provider's letterhead and include:

• beneficiary's name,
• date of each service,
  
• procedure code or description of each service,
• billed amount for each service,
• provider's name if services were received from an individual provider (circle provider's name if from a group or clinic with several provider names on the bill), and
  
• provider's address.

Other Health Insurance (OHI) Explanation of Benefits (EOB)

• If you have OHI, it is primary to TRICARE (Exceptions: state Medicaid programs, state Victims of Crimes programs, Indian Health Services and TRICARE supplement plans).
• Be sure there is a matching EOB for each charge on the provider's bill.
• If your OHI denied a charge as a duplicate you will need to include the originally processed EOB for the same service.
• If your OHI denies a service as not medically necessary you will need to appeal to your OHI before TRICARE can consider the claim.

Where to Send the Claim 

TRICARE Medical Claims (dates of service prior to Jan. 1, 2025)

Health Net Federal Services, LLC
c/o PGBA, LLC/TRICARE
PO Box 202112
Florence, SC 29502-2112

If the date of service is before Jan. 1, 2025, AND the claim was submitted to HNFS by April 30, 2025, check with HNFS:

• By phone through March 30, 2025
• Online through June 30, 2025

If the date of service is before Jan. 1, 2025, AND the claim was submitted to TriWest on or after May 1, 2025, check with TriWest 

• If the date of service is on or after Jan. 1, 2025, check with TriWest

Check with TriWest regardless of date of service beginning May 1, 2025

TRICARE requires beneficiaries access individual Explanation of Benefits (EOBs) online. You can continue to access EOBs for claims processed by HNFS through June 30, 2025. 

To do this, log in and click on “EOB Summary.” If you would like paper copies of claim information, you can call customer service (through March 30, 2025) to request individual EOBs on a per-instance basis. 

HNFS can only accept updates to your other health insurance information if it's needed to process a claim for services rendered prior to Jan. 1, 2025. To do this, you can mail in or fax this OHI Questionnaire. 

If you need to update your other health insurance information for 2025, you must contact TriWest.