New claim submissions

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:

• Third Party Liability (TPL) included
• Other Health Insurance (OHI) payment included
• With medical records attached

New claim submission instructions:

From January 1, 2025, to April 30, 2025, the current payer organization (WPS) will continue to process claims with a 2024 Date of Service (DOS). After April 30, 2025, claims with a 2024 DOS will no longer be accepted via 2024 processes.

For claims with 2024 DOS submitted before May 1st, 2025:

Submit claims online through the provider access claims center in provider self-service.

EDI claims payer ID is TREST.

TRICARE East Region
Attn: New Claims
PO Box 7981
Madison, WI 53707-7981

Fax: (608) 327-8522

For claims submissions with a 2025 DOS, or after April 30th 2025:

XpressClaims will be the online claims and claims related document submission system beginning January 1, 2025, and will be available in provider self-service.

EDI claims payer ID is 99727.

The payer ID will need to be placed in the following data elements within your X12 837 claim files: ISA-08, GS-03, NM1-09 (with 40 qualifier).

For the clearinghouse, new direct submitters must file a trading partner agreement and enrollment form to be assigned a mailbox/submitter ID. If your clearinghouse already files claims to PGBA for other lines of business, you need to ensure that the TRICARE EAST payer ID 99727 is made available as an option. If your clearinghouse does not submit to PGBA, providers, vendors or clearinghouses that can create an ANSI X12 electronic file, and have telecommunications capabilities, can upload files to PGBA directly. Batch claims processing is available through our EDI Gateway mailbox system. Providers must file a EDI Provider Trading Partner Agreement in order to submit claims electronically. Please contact the PGBA EDI Help Desk at (800) 259-0264, or email EDI.TRICARE@PGBA.com for assistance with EDI set-up.

Fax: (877) 489-0007

Humana Military Claims
Attn: New Claims
PO Box 202146
Florence, SC 29502-2146

Claims - Corrected/Revised

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:

For claims with 2024 Dates of Service (DOS), and submitted by April 30th, 2025:

EDI Payer ID: TREST (Preferred method)

TRICARE East Region Claims
Attn: Corrected Claims
PO Box 8904
Madison, WI 53708-8904
Fax: (608) 327-8523

For claims submissions with a 2025 DOS, or after April 30th 2025:

EDI Payer ID: 99727 (Preferred method)
Fax: (877) 489-0007

Humana Military Claims
Attn: Corrected Claims
PO BOX 202146
Florence, SC 29502-2146

Claims - Recoupment/Refund

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 claims with 2024 Dates of Service (DOS), and submitted by April 30th, 2025:

EDI Payer ID: TREST (Preferred method)

TRICARE East Region Claims
Attn: Corrected Claims
PO Box 8904
Madison, WI 53708-8904
Fax: (608) 327-8523

For claims submissions with a 2025 DOS, or after April 30th 2025:

EDI Payer ID: 99727 (Preferred method)
Fax: (877) 489-0007

Humana Military Claims
Attn: Corrected Claims
PO BOX 202146
Florence, SC 29502-2146

Claim recoupment/refund submissions for a 2024 DOS, please complete the proactive recoupment form (a) before April 30, 2025:

TRICARE East Region
Attn: Refunds/Recoupments
PO Box 7937
Madison, WI 53707-7937

Claim recoupment/refund submissions for a 2025 DOS, OR After April 30, 2025, please complete the proactive recoupment form (b):

Humana Military Claims
General Correspondence
PO Box 202147
Florence, SC 29502-2147

To check the status of a claim, please log in or create an account:
Provider self-service

Claims related medical records

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:

For claims with 2024 DOS submitted before May 1st, 2025:

TRICARE East Region
Attn: Medical Review
PO Box 7856
Madison, WI 53707-7856

Fax: (608) 221-7540

For claims submissions with a 2025 DOS, or after April 30th 2025:

Humana Military Claims
Attn: Medical Review
PO Box 202157
Florence, SC 29502-2157

Durable Medical Equipment (DME) and Certificates of Medical Necessity (CMN)

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. Providers should keep the CMN on file for at least one year.

DME CMN information:

For claims with 2024 DOS submitted before May 1st, 2025:

You can mail or fax the supporting documentation Certificate of Medical Necessity (CMN) (and/or physician order) to:

PO Box 8923
Madison, WI 53707-8923

Fax: (608) 221-7542

For claims submissions with a 2025 DOS, or after April 30th 2025:

You can submit supporting documentation (CMN and/or physician order) electronically through provider self-service in the provider access claims center by clicking on the "send documents" link.

You may also mail or fax in supporting documentation (CMN and/or physician order) to:

PO Box 202150
Florence, SC 29502-2150

Fax:  (877) 489-0037

Prior authorization/referral related medical records

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

Referrals/authorizations

Appeals, allowable charge appeal and claims reconsideration

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:

• The patient, any age.
• The parent or guardian of a patient under age 18 (except sensitive diagnosis claims).
• The patient may appoint a representative.

Note: A completed appointment of Appeal Representative (AOR) form must be submitted with the appeal request. Appointed representatives MAY include:

• Network providers; but, network providers cannot appeal without an AOR specific to the appeal being requested
• The legal representative of the estate of a deceased beneficiary
• An attorney acting on behalf of an otherwise proper appealing party listed above

Who cannot appeal:

• Congressional Appeal Offices
• Non-participating providers - Does not agree to accept the TRICARE-allowable amount
• Health Benefit Advisors (HBA)
• Beneficiary Service Representatives (BSR)
• Network providers (unless an AOR form is on file indicating beneficiary has given permission for the provider to act on his/her behalf)

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

Allowable charge review

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:

• Allowed amount disputes
• Charges denied due to requested information not received
• Coding issues
• Cost-share and deductible issues
• Eligibility denials
• Other Health Insurance (OHI) issues
• Penalties for no authorization
• Third Party Liability (TPL) issues
• Timely filing limit denials
• Wrong procedure code

Allowable charge appeals are processed by WPS.

Allow charge submissions:

Allowable charge appeals are processed by PGBA.

TRICARE Operation Manual Chapter 11 Section 7

Allow charge submissions:
Customer Service
Humana Military
PO Box 202146
Florence, SC 29502-2146

Fax: (877) 489-0011

Hours of operation: 8 AM to 7 PM ET
Phone: (800) 444-5445

Claims reconsideration

Participating providers may have claims reconsidered through medical review for issues including:

• Requests for verification that the edit was appropriately entered for the claim
• Situations in which the provider submits documentation substantiating unusual circumstances existed 

TRICARE Operation Manual Chapter 12 Section 3

Claims reconsideration submissions:

Humana Military Claims
ATTN: Reconsideration request
PO Box 202146
Florence, SC 29502-2146

Fax: (877) 489-0011

Hours of operation: 8 AM to 7 PM ET
Phone: (800) 444-5445

Reconsideration FAQs

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:

From January 1, 2025, to April 30, 2025, the current payer organization (WPS) will continue to process claims with a 2024 Date of Service (DOS). After April 30, 2025, claims with a 2024 DOS will no longer be accepted via 2024 processes.

For claims with 2024 DOS submitted before May 1st, 2025:

TPL form and TPL requested medical record submissions:

TRICARE East Region
Attn: Third Party Liability (TPL)
PO Box 8968 Madison, WI 53707-7539

Fax: (608) 221-7539

For claims submissions with a 2025 DOS, or after April 30th 2025:

Submit TPL form and TPL requested medical record submissions electronically through provider self-service in the provider access claims center by clicking on the "send documents" link.

You may also mail or fax in TPL form to:

Humana Military Claims
Attn: Third Party Liability (TPL)
PO Box 202152
Florence, SC 29502-2152
Fax: (877) 489-0041

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@HumanaMilitary.com

CAP DME cost reimbursement

TRICARE authorizes Humana Military to reimburse hospitals for allowed Capital and Direct Medical Education costs, known as CAP DME. Reimbursement is subject to regulations as outlined by TRICARE Reimbursement Manual (TRM).

For requests with 2024 Dates of Service (DOS), and submitted by April 30th, 2025 email this form:

Reimbursement of capital and direct medical education costs (a) to: CAPDME@WPSIC.com.

For requests submitted after April 30th, 2025 email this form: Reimbursement of capital and direct medical education costs (b) to: T5EAST.CAPDME@PGBA.com.