Claims reconsiderations

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

If a line on a claim is rejected, first review the medical documentation for any additional diagnosis and, if found, submit it on a corrected claim. If other diagnoses are not found after review, providers may request reconsideration.

Send supporting medical record information to:

TRICARE East Region claims
ATTN: Correspondence/Corrected claims
P.O. Box 8923
Madison, WI 53707-8923

Providers are not permitted to bill TRICARE beneficiaries for services rejected by claims auditing.

TRICARE claims information