Resources | Humana Military

Forms

Accessing TRICARE DD forms:

Due to security settings, you may not be able to view certain DD forms in your web browser. If you encounter an issue viewing a form in your web-browser, right-click and select "Save as" to save to your computer. You can then open the form using your system's default program for viewing PDFs. You can also try accessing the form directly from the official DoD forms site.

Claims

Billing and enrollment

HIPAA

Miscellaneous

Claim forms

Appointment of representative

Claim form (DD2642)

Other Health Insurance (OHI) questionnaire

Public facility use certification form

Timely filing waiver

Third party liability claim form (DD2527)

New claim submissions

Attn: New Claim Submissions

PO Box 7981

Madison, WI 53707-7981

Fax: 1-608-327-8522

Third Party Liability (TPL) submissions

Attn: Third Party Liability

PO Box 8968

Madison, WI 53708-8968

Fax: 1-608-221-7539

Billing and payment options

Make a payment

Set up allotment

Set up recurring payment with bank account

Set up recurring payments with credit card

Log in to see your billing summary or make a payment

Enrollment forms

Continued Health Care Benefit Program (CHCBP)

Prime enrollment, disenrollment and PCM change form (DD2876)

Select enrollment, disenrollment and change form (DD3043)

TRICARE Young Adult (TYA) application (DD2947)

General release of information authorization requests

General release of information authorizations should be completed online through beneficiary self-service. Sensitive diagnosis and revocation options are not available in self-service at this time.

Log in or register to submit a general release of information request.

Paper submission forms

Authorization for release of information form (general)

Authorization for release of information form (sensitive diagnosis)

Revocation of prior authorization

Miscellaneous forms

Case management referral form

COVID-19 Vaccine Screening and Immunization Documentation (DHA Form 207)

TRICARE resources