Please note: Network providers are required to submit claims on your behalf. If the provider who rendered services is a network provider, please follow-up with them to have your claims submitted.

Step one: Download and complete DD Form 2642

• Download and complete DD Form 2642

Step two: Gather supporting documentation

Attach a readable copy of the provider's bill to the claim form, and make sure it contains the following information:

• 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 section 8a on the form)

IMPORTANT:Please ensure that the patient’s name and sponsor’s name, as well as the Sponsor's Social Security Number (SSN) or Department of Defense Benefits Number (DBN) (eligible former spouses should use their SSN) are on ALL attachments.

Step three: Submit by fax or US Mail

• Fax to: (608) 327-8522
• Mail to:
  TRICARE East Region: New claims
  PO Box 7981
  Madison, WI 53707-7981

If you need to file a claim for care you received overseas, you must file the claim with the overseas claims processor using the address for the area where you got the care. Learn more