Submitting Claims

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

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.
See additional information about how TRICARE works with OHI.

TRICARE Medical Claims

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

TRICARE Pharmacy Claims

TRICARE Pharmacy Claims
Express Scripts
PO Box 52132
Phoenix, AZ 85072