Due to a known system issue, claims submissions are taking longer than usual to process. We encourage you to continue submitting claims as you normally would, and we will process them as soon as possible. We apologize for the inconvenience and appreciate your patience.

Due to potential mail delays caused by COVID-19, we encourage you to use our electronic processes whenever possible. If you have not already registered your location(s) for electronic claims, please complete the EDI Express Enrollment process.

Claims

Explore these resources to find tips and educational information to help facilitate prompt claims processing.


Proactive recoupments

Providers who have been overpaid and wish to return the additional funds can submit a recoupment form


TRICARE rates

CHAMPUS Maximum Allowable Charges (CMAC) is the most frequently used TRICARE reimbursement method for procedures or services. CMAC rates are determined by procedure code, ZIP Code, the setting where the services were rendered and the provider type. View CMAC rates


Capital and direct medical education

TRICARE authorizes regional contractors to reimburse hospitals for allowed capital and direct medical education costs. Reimbursement is subject to regulations as outlined by TRICARE. View regulations


TRICARE reimbursement methodologies

The TRICARE Reimbursement Manual provides the methodology for pricing allowable services and items and for payment to specific categories and types of authorized providers. Learn more


No government pay list

The no government pay list is made up of procedures and services outside of the scope of TRICARE and are considered noncovered. View now