Claim supporting documentation

Quick links:

Claims related medical records

Claims related medical records definition:

Medical records may be required and requested for claim approval purposes. Please return the requested records with the request letter as the coversheet.

Claims related medical records submission:

TRICARE East Region
Attn: Medical Review
PO Box 7856
Madison, WI 53707-7856

Fax: (608) 221-7540

Durable Medical Equipment (DME) and Certificates of Medical Necessity (CMN)

CMN definition:

A DME is a document signed by the prescribing provider containing clinical information that supports the need for each item, services or supplies requested for a beneficiary. A physician’s order or prescription itself can take the place of the CMN as long as it includes the necessary elements and signature. It is very important that the CMN or physician order be complete and current for the services/supplies/equipment to be covered. A copy of the CMN or order must be submitted with the claim or may be faxed. Providers should keep the CMN on file for at least one year.

CMN submission:

DME CMN information:
TRICARE East Region
PO Box 8923
Madison, WI 53707-8923

Fax: (608) 221-7542

Prior authorization/referral related medical records

Referral related definition:

For Active Duty Service Members (ADSM) and all other beneficiaries enrolled in a TRICARE Prime plan, Primary Care Manager (PCM) must provide a referral for most services they can't provide. For TRICARE Select beneficiaries, referrals are not required, but some services may require prior authorization from Humana Military. When completing the referral, always include the sponsor’s TRICARE ID, diagnosis and clinical data explaining the reason for the referral.

Referral related submission:

Fax: (877) 548-1547
Phone: (800) 444-5445

Fax: (877) 378-2316
Phone: (800) 444-5445