Claims Form

Need to fill out a claim form?

To file a claim, obtain and fill out a DD form 2642 patient’s request for medical payment. You can also visit a military hospital or clinic. If you have claims questions, call Humana Military's toll-free number: 1-800-444-5445.

Information required for claim form:

  • Claims must be filed within one year of the date of service or within one year of the date of an inpatient discharge.
  • Be sure to complete all 12 blocks of the form correctly and sign it. Note: Providers submit inpatient facility claims.
  • When filing a claim, attach a readable copy of the provider’s bill to the claim form, making sure it contains the following:
    • Sponsor’s Social Security number (SSN) (Eligible former spouses should use their Social Security number.).
    • Provider’s name and address (If more than one provider’s name is on the bill, circle the name of the person who treated you.).
    • Date and place of each service.
    • Description of each service or supply furnished.
    • Charge for each service.
    • Diagnosis (If the diagnosis is not on the bill, be sure to complete block 8a on the form.).

Send claims to:
TRICARE South Region
Claims Department
P.O. Box 7031
Camden, SC 29020-7031

Note: You may be required to pay up front for services if you see a non-network TRICARE-authorized provider who chooses not to participate on the claim. In this case, TRICARE will reimburse you directly for the TRICARE allowable charge minus any applicable deductible and cost-share. Remember that non-participating providers may charge you up to 15% above the TRICARE allowable charge for services in addition to your cost-share and/or deductible.

If you receive care while traveling, file TRICARE claims based on where you live, not where you received care. Be sure to keep a copy of the paperwork for your records.