Medical records may be required and requested for claim approval purposes. Please return the requested records with the request letter as the coversheet.
Claims related medical records submissions
TRICARE East Region
Attn: Medical Review
PO Box 7856
Madison, WI 53707-7856
Fax: (608) 221-7540
A DME is a document signed by the prescribing provider containing clinical information that supports the need for each item, services or supplies requested for a beneficiary. A physician’s order or prescription itself can take the place of the CMN as long as it includes the necessary elements and signature. It is very important that the CMN or physician order be complete and current for the services/supplies/equipment to be covered. A copy of the CMN or order must be submitted with the claim or may be faxed. Providers should keep the CMN on file for at least one year.
DME CMN information
TRICARE East Region
Attn: DME/CMN
PO Box 8923
Madison, WI 53707-8923
Fax: (608) 221-7542
For Active Duty Service Members (ADSM) and all other beneficiaries enrolled in a TRICARE Prime plan, Primary Care Manager (PCM) must provide a referral for most services they can't provide. For TRICARE Select beneficiaries, referrals are not required, but some services may require prior authorization from Humana Military. When completing the referral, always include the sponsor’s TRICARE ID, diagnosis and clinical data explaining the reason for the referral.
Submit referral online for quickest response
Fax: (877) 548-1547
Phone: (800) 444-5445
Behavioral healthcare referrals and authorizations
Fax: (877) 378-2316
Phone: (800) 444-5445
