Verifying eligibility

TRICARE beneficiaries should present their uniformed services ID card at the time of service to verify their eligibility. Those cards include Common Access Cards (CACs), military ID cards or eligibility letters (examples shown below). Be sure to check the expiration date before providing care and make a copy of both sides of the ID card for your patient files.

Note: A CAC or ID card alone does not confirm TRICARE eligibility. Most eligibility is based on the Defense Enrollment Eligibility Reporting System (DEERS). Providers can use the sponsor’s Social Security Number (SSN) or DoD benefits number (DBN) to verify eligibility using provider self-service. Verify eligibility now

Common Access Card (CAC)

Common access cards are used to photo identify active duty personnel, selected reserves, National Guard, National Oceanic and Atmospheric Administration, U.S. Public Health Services and U.S. Coast Guard members and their families.

Military identification cards

  • Active Duty Service Members (ADSM), family members over age 10, retirees and family members will have a military ID card, and like the CAC, will have a photo image of the card bearer.
  • DBN/member ID or SSN: Providers may verify the beneficiary’s eligibility using the information supplied on the card. As new military ID cards are issued, a new member ID will replace the sponsor SSN. This new member ID can still be used to verify eligibility. Humana Military’s web-based eligibility check option allows you to use either the sponsor SSN or the new member ID to verify eligibility.
  • Expiration date: Check the date in the “expiration date” box on the ID card. If expired, the beneficiary must update his or her information in the Defense Enrollment Eligibility Reporting System (DEERS) and be issued a valid card.
  • Civilian: Check the back of the ID card to verify eligibility for TRICARE civilian care. The center section of the card should read “yes” in the “civilian” box.

Note: Beneficiaries who are dual-eligible will have Medicare Part A and Part B and TRICARE. Military ID cards will be similar. An eligibility check will verify TRICARE coverage as secondary.

TRICARE cannot accept or cross-walk a 10-digit number in the Member ID field, which causes claims to reject. Numbers containing dashes also generate an error. Some possible ID numbers you may encounter:

  • SSN: A nine-digit number no longer on ID cards, which is acceptable for claims submissions.
  • DoD ID number: A 10-digit number on the front of ID cards, which is not acceptable for claims submissions.
  • DBN: An 11-digit number on the back of some ID cards, which is acceptable for claims submissions (Do not include any dashes).

If the ID card does not include a 9-digit sponsor SSN or an 11-digit DBN, ask the beneficiary to provide the two numbers.

Please review your systems to ensure that your claims submissions contain the appropriately formatted nine-digit SSN or 11-digit DBN. If you have any questions, please call WPS Electronic Data Interchange (EDI) Help Desk at (800) 782-2680, menu option 1.

Providers may verify TRICARE Prime or TRICARE Select eligibility in one of the following ways:

  • With provider self-service, find a patient’s status along with information about the TRICARE copay, cost-share, Other Health Insurance (OHI) and catastrophic cap.
  • Call Humana Military’s IVR line at (800) 444-5445. Access the provider main menu, and press # for eligibility and benefits.
  • Providers have the right to collect out-of-pocket costs from beneficiaries prior to seeing the TRICARE patient, or they can file the claim first if it is easier. Both the patient’s Explanation Of Benefits (EOB) and the provider remittance will include copay or cost-share amounts owed.
  • Identification cards for family members age 75 and older.
  • All eligible family members and survivors age 75 or older are issued permanent ID cards. These cards should read INDEF (i.e., indefinite) in the expiration date box.
  • ADFMs remain eligible for TRICARE Prime and TRICARE Select while the sponsor is on active duty. Once the sponsor retires from active duty, the sponsor and his or her family members who are entitled to premium-free Medicare.
  • Part A must also have Medicare Part B to keep their TRICARE benefits.
  • TRICARE Reserve Select (TRS), TRICARE Retired Reserve (TRR), CHCBP and US Family Health Plan (USFHP) beneficiaries are not required to have Medicare Part B to remain covered under these programs.
  • Civilian: Check the ID card to verify eligibility for TRICARE civilian care. The Civilian box should read “yes”. A TRICARE For Life (TFL) beneficiary with an ID card that reads “no” in this block may still use TFL if he or she has both Medicare Part A and Medicare Part B coverage.

TRICARE eligibility