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.

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 (EXCEPT DME claims). All network providers are REQUIRED to submit claims on your behalf to insure the best discount available.