How to Fix TRICARE Billing Errors & Denied Claims (2026) | TRICARE.com

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## Quick answer If you see a TRICARE billing error, first compare your provider’s invoice against the **Explanation of Benefits (EOB)** from your regional contractor (Humana Military or TriWest). Most errors stem from incorrect "Other Health Insurance" (OHI) information or improper medical coding; you should contact the provider's billing office first, then file a formal claim appeal if the issue remains unresolved.

## Details Billing errors in the TRICARE system typically fall into three categories: provider coding errors, administrative processing errors by the contractor, or outdated beneficiary information in DEERS.

### Common Causes of Errors * **Missing "Other Health Insurance" (OHI):** If you have a private health plan through an employer, TRICARE is legally the secondary payer. If TRICARE thinks you have OHI but you don’t (or vice versa), they will automatically deny the claim. * **Coding Discrepancies:** A doctor may use a CPT code that TRICARE deems "not medically necessary" for your specific diagnosis. * **Out-of-Network Penalties:** If you are on TRICARE Prime and see a specialist without a referral, you may be billed under the **Point-of-Service (POS) option**. In 2026, this includes a $300 individual deductible and 50% cost-shares which can look like a "billing error" compared to your usual $0 or low-cost copays.

### Steps to Resolve a Billing Error 1. **Check the EOB:** Access your EOB via the **Humana Military** (East) or **TriWest** (West) secure portals. This document shows what the provider billed, what TRICARE allowed, and exactly what you owe. 2. **Contact the Provider:** If the EOB shows the claim was denied because of a "missing modifier" or "incorrect code," the provider must resubmit the claim. Do not pay the bill until the provider corrects the submission. 3. **Update DEERS:** If the error is due to eligibility, ensure your status is correct in the Defense Enrollment Eligibility Reporting System (DEERS). 4. **File an Appeal:** If TRICARE denies a service you believe is covered, you have 90 days from the date of the EOB to file a written appeal.

### Debt Collection Assistance If a billing error has resulted in a provider sending your account to a collection agency, contact a **Debt Collection Assistance Officer (DCAO)** at your nearest Military Medical Treatment Facility (MTF). They are specialized staff members who help beneficiaries resolve confirmed billing errors that affect credit scores.

## Who this affects * **Active Duty Family Members (ADFMs):** Usually affected by OHI or referral errors. * **Retirees and their families:** Often see errors related to TRICARE Select enrollment fees or catastrophic cap tracking. * **National Guard and Reserve:** Frequently face billing issues during transitions between "active" and "inactive" status in DEERS. * **Providers:** Non-network providers who do not understand TRICARE’s maximum allowable charge (TMAC) may "balance bill" patients, which is often prohibited.

## Sources * **TRICARE.mil:** [Filing Claims](https://www.tricare.mil/claims) * **Humana Military (East):** [Claims Resource Center](https://www.humanamilitary.com/beneficiary/claims/) * **TriWest Healthcare Alliance (West):** [Beneficiary Claims and Billing](https://www.triwest.com/en/beneficiary/claims-and-billing/) * **Defense Health Agency (DHA):** [Debt Collection Assistance Officers](https://tricare.mil/dcao)