(Claims) How do I handle non-covered service requests?

Before delivering care, network providers must notify TRICARE patients if services are not covered. The beneficiary must agree in advance and in writing to receive and accept financial responsibility for non-covered services. The Request for Non-Covered Services form can be used to document the specific services, dates, estimated costs, and other information. If the beneficiary does not sign a Request for Non-Covered Services form or equivalent, you are financially responsible for the cost of non-covered services you deliver.

Hold Harmless Policy for Network Providers

A network provider may not bill a TRICARE beneficiary for services not covered, except in the following circumstances:

• If the beneficiary did not inform the provider that he or she was a TRICARE beneficiary.
• If the beneficiary was informed that services were not covered and agreed in advance and in writing to pay for the services.

Hold Harmless Policy for Non-Network Providers

Non-network providers should also inform beneficiaries in advance if services are not covered. Although not required, non-network providers are strongly encouraged to use a Request for Non-Covered Services form or their own office equivalent to document payment agreements.