A claim is considered “new” if it has not been submitted to TRICARE previously. New claims may have additional information attached or included within the claim data such as:
New claim submission instructions
EDI Payer ID: TREST (Preferred method)
Red optical character recognition (preferred) and black paper claim forms should be sent to:
TRICARE East Region Claims
Attn: New Claims
PO Box 7981
Madison, WI 53707-7981
Fax: (608) 327-8522
A corrected claim is used to update a previously processed claim with new or additional information. A corrected claim is beneficiary and claim specific and should only be submitted if the original claim information was incomplete or inaccurate. A corrected claim does not constitute an appeal.
Corrected/Revised claim submission instructions
EDI Payer ID: TREST (Preferred method)
TRICARE East Region Claims
Attn: Corrected Claims
PO Box 8904
Madison, WI 53708-8904
Fax: (608) 327-8523
Payer Recoupment Request: A claim recoupment is a request by the provider or the health insurance payer, to recover funds involved in an overpayment. A payer may identify an overpayment due to unknown other health insurance. If the provider sends claims electronically and receives payment electronically, the provider can initiate an electronic recoupment that will offset a future payment by the payer and eliminate the need for the provider to send a refund check which requires manual intervention. If the provider is not transacting electronically, the provider will need to send a refund check.
Provider Recoupment Request: A claim payment recoupment may also be requested by a provider if the provider identifies an error in payment. With notification, the payer will recover the overpayment on a future payment to the provider.
For claim recoupment/refund submissions, please complete the proactive recoupment form and mail to:
TRICARE East Region
Attn: Refunds/Recoupments
PO Box 7937
Madison, WI 53707-7937
To check the status of a claim, please log in:
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
Medical necessity appeals are appeals related to a medical necessity denial are processed by Humana Military.
The appeal process is only applicable to charges denied as not covered or not medically necessary and are only accepted from appropriate appealing parties.
A proper appealing party is:
Note: A completed appointment of Appeal Representative (AOR) form must be submitted with the appeal request. Appointed representatives MAY include:
Who cannot appeal:
Learn how to file an appeal with Humana Military
Appeals submissions:
Appeal submission process FAQs
HMHSRECON@humana.com (Preferred method)
Fax: (877) 850-1046
Humana Military Appeals
PO Box 740044
Louisville, KY 40201-7444
If a provider or a beneficiary has concerns about how a claim processed, an administrative review, also known as an allowable charge review, can be requested. It’s important to differentiate allowable charge reviews from medical necessity denial appeal requests.
Providers can submit a request for an administrative review when there are concerns about how a claim processed. The following are common reasons a provider may submit a request for administrative review: a request for administrative review, including:
Allowable charge appeals are processed by WPS.
Allow charge submissions:
Customer Service
TRICARE East Region
PO Box 8923
Madison, WI 53708-8923
Hours of operation: 8 AM to 7 PM ET
Phone: (800) 444-5445
Fax: (608) 221-7536
Participating providers may have claims reconsidered through medical review for issues including:
Claims reconsideration submissions:
Customer Service
TRICARE East Region
PO Box 8923
Madison, WI 53708-8923
Hours of operation: 8 AM to 7 PM ET
Phone: (800) 444-5445
Fax: (608) 221-7536
The Federal Medical Recovery Act allows TRICARE to be reimbursed for its costs of treating you if you are injured in an accident that was caused by someone else.
TPL process - beneficiary:
Beneficiaries will receive the Statement of Personal Injury-Possible Third Party Liability (DD Form 2527) if a claim is received that appears to have TPL involvement.
The beneficiary must complete and sign this form within 35 calendar days and return the form to the address below. If the beneficiary is unable to complete form DD2527, the provider may submit a cover letter identifying the inability to complete and provide medical records.
TPL process - medical records:
Medical records submitted on behalf of a beneficiary and medical records requested related to a claim in process should be routed to the Madison, WI address or fax number below.
Please refer to claim support documentation for correct routing of all other medical record requests.
TPL process - provider:
Refunds related to a TPL payment should be managed through the claim recoupments/refund process.
TPL form and TPL requested medical record submissions:
TRICARE East Region
Attn: Third Party Liability (TPL)
PO Box 8968
Madison, WI 53707-8968
Fax: (608) 221-7539
Attorneys or insurance agencies:
Subrogation/Lien cases involving TPL for TRICARE East beneficiaries should be submitted through the contact methods below:
Humana Military
PO Box 740062
Louisville, KY 40201-7462
Fax: (800) 439-7482
Email: HMHSRoutineCorrespondence@humana.com
TRICARE authorizes Humana Military to reimburse hospitals for allowed CAP DME costs. Reimbursement is subject to regulations as outlined by TRICARE Reimbursement Manual.
Reimbursement of CAP DME costs
Requests should be emailed to: CAPDME@WPSIC.com
To provide ABA services to TRICARE beneficiaries, ABA providers must be TRICARE-certified. TRICARE recognizes the following certification types:
Once certified, providers can apply to join the TRICARE East network. For ABA Provider requirements, please see the TRICARE Operations Manual, Chapter 18, Section 4.
Providers must be TRICARE-certified to file claims and receive payment for TRICARE services. Certified providers must meet the licensing and certification requirements of TRICARE regulations and practice for that area of healthcare.
Electronic submissions: To ensure your electronic submission is processed in a timely manner, please confirm you are submitting the information in the correct portal, inbox or web form. To avoid additional delays, please only include details on a single beneficiary and to not combine requests.
Fax or mail submissions: TRICARE may ask for additional details, including for you to use the letter you received again as the coversheet for the information that you return. The letters, utilized as a coversheet, allow Humana Military to quickly document and identify beneficiaries via barcode and OCR recognition, speeding up the process. To ensure your documentation is processed quickly, please send a single correspondence or fax with information regarding a single beneficiary. If multiple pieces of correspondence are mailed at the same time, please ensure they are divided with coversheets. Humana Military accepts HIPAA-compliant electronic faxes sent using HIPPA-compliant companies, such as UpDox, Faxage or SRFax, among others available through a web search.
