TRICARE Claim Definition & Guide | How Medical Bills are Paid

*TRICARE.com is an independent reference site and is not the official TRICARE program. For official policy, visit TRICARE.mil.*

## Definition A claim is a formal request for payment submitted to TRICARE by either a healthcare provider or a beneficiary after medical services or supplies have been received.

## What it means in practice In the TRICARE system, claims are the mechanism by which your medical bills get paid. For the vast majority of beneficiaries using network providers (under TRICARE Prime or TRICARE Select), you will never have to file a claim yourself. Network doctors and hospitals are contractually required to file claims directly with the regional contractor—**Humana Military** in the East Region or **TriWest Healthcare Alliance** in the West Region.

However, if you visit a non-network provider or receive care overseas, you may be required to pay the full cost upfront and file a manual claim for reimbursement. For example, if you are a TRICARE Select enrollee in 2026 and see an out-of-network therapist who does not file claims, you must submit **DD Form 2642** along with an itemized bill. TRICARE will then process the claim, apply your deductible (e.g., $188 for an individual Group A sponsor), and send you a check for the covered portion.

Timeliness is critical for TRICARE claims. For care received in the United States and U.S. territories, claims must be filed within one year of the date of service. For overseas care, you have three years from the date of service to file. If you miss these deadlines, TRICARE will deny the claim, and you may be held responsible for the entire bill. You can track the status of your claims by logging into the secure portals provided by Humana Military, TriWest, or Express Scripts for pharmacy-related entries.

After a claim is processed, you will receive an **Explanation of Benefits (EOB)**. This is not a bill, but a summary showing what the provider charged, what TRICARE paid, and what you owe (your cost-share or copayment). For instance, a 2026 specialist visit copay for a Retiree in TRICARE Prime might be $39; the EOB will confirm that TRICARE covered the remainder of the negotiated rate.

## Related terms * **Explanation of Benefits (EOB):** A statement sent to the beneficiary explaining what medical services were paid for and any remaining patient responsibility. * **Allowed Amount:** The maximum amount TRICARE will pay for a specific procedure or service, regardless of what the doctor actually bills. * **Deductible:** A fixed dollar amount the beneficiary must pay out-of-pocket each year before TRICARE begins to pay for covered services. * **DD Form 2642:** The official "TRICARE Do-It-Yourself" claim form used by beneficiaries to request reimbursement for medical care. * **Other Health Insurance (OHI):** Any other health insurance you have; by law, OHI pays claims first, and TRICARE pays second.

## Sources * **TRICARE.mil:** [Filing Claims](https://www.tricare.mil/claims) * **TriWest Healthcare Alliance (West Region):** [Claims Overview](https://www.triwest.com) * **Humana Military (East Region):** [Claims Submission](https://www.humanamilitary.com)