Claims

In most cases, providers will submit claims on behalf of TRICARE beneficiaries for healthcare services. However, there are some instances in which you can submit your own claim.

Disclaimer: Using non-network providers


Beneficiaries MUST submit claims:

  • When they receive service within a network ER facility but the provider is out-of-network.

Beneficiaries can submit claims:

  • From a non-network provider for services performed in a doctor’s office, such as injections, immunizations, casting broken arms, etc.
  • For specialty pharmacy items administered at the doctor’s office. This might include immunizations or allergy shots.
  • For Durable Medical Equipment (DME) and supplies.

Beneficiaries cannot submit:

  • Institutional charges (submitted by both network and non-network facilities) for services rendered at a facility and not a doctor’s office. They include ambulatory surgery, radiological services and lab work.
  • Claims for services performed by a network provider. All network providers are REQUIRED to submit claims on your behalf to insure the best discount available.

View your claims

Find information on how to file claims, appeals and grievances, check status of claims, how to view your electronic Explanation of Benefits (EOB) and more. Watch short tutorial

 

Learn more

Your Explanation of Benefits (EOB) is now available online

When you register for beneficiary self-service, you will have the ability to view and print your TRICARE EOB, giving you access to your information anytime. Remember, your EOB is an itemized statement that shows what action TRICARE has taken toward your claims and is not a bill.

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