TRICARE and third-party liability insurance

The Federal Medical Care Recovery Act allows the government to be reimbursed for costs associated with treating a TRICARE beneficiary who has been injured in an accident caused by someone else. When a claim appears to have possible third-party involvement, required actions can affect total processing time.

Inpatient claims submitted with diagnosis codes 800 to 999 regardless of the billed amount, and outpatient professional claims that exceed a TRICARE liability of $500, which indicate an accident, injury or illness, will be pended for research. Claims will not be processed further until the beneficiary completes and submits a Statement of Personal Injury— Possible Third Party Liability (DD Form 2527)

TRICARE claims information