Tricare East Region Claims - In most cases, providers file claims for health care services on behalf of TRICARE beneficiaries. However, there are certain circumstances in which you can bring your own claim.
Find information on filing claims, appeals and complaints, checking claim status, viewing your Electronic Statement of Benefits (EPO), and more. Watch a short tutorial
Tricare East Region Claims
All TRICARE claims are subject to the TRICARE Maximum Allowable Charge (TMAC). Subject to the laws of Medicare's allowable fees, the TMAC is the maximum amount TRICARE will pay a physician or other health care provider for a procedure, service, or equipment.
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Non-participating carriers can charge you up to 15% more than TMAC, known as balance billing. If you're using a non-participating provider, you'll have to pay all of these additional fees up to 15%. See TRICARE.mil/Costs/Cost-Terms for additional information.
All TRICARE Authorized Providers meet TRICARE licensing and certification requirements and are TRICARE certified to provide care to TRICARE beneficiaries. TRICARE-authorized providers can be TRICARE-compliant physicians, hospitals, emergency providers (such as laboratories, radiology centers), and pharmacies. If you see a health care provider who is not authorized by TRICARE, you will be responsible for the entire cost of your health care. Find a list of TRICARE Authorized Suppliers
According to the contract, the network provider is obliged to submit a fee claim to the beneficiary for the services provided. Beneficiaries cannot claim for services provided by the network provider.
The network provider may accept a co-payment/co-payment from the beneficiary prior to providing the service (the beneficiary may not prepay for services provided by the network provider unless it is their co-payment/co-payment).
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Participating non-network providers may choose to participate on a claims basis. They agree to accept payment from TRICARE directly and TMAC (less any patient fees paid by the beneficiary) as payment in full.
For non-participating non-network providers, beneficiaries may be required to prepay for services provided and file their own claims. These providers have not agreed to submit your claim. Providers also have the right to charge up to 15% on top of TRICARE-allowed charges for services (the beneficiary is responsible for paying this amount in addition to any applicable patient charges).
Please note that claims will be rejected if the provider is not authorized/certified by TRICARE on the date the service is provided. If the provider does not complete and submit supporting documentation, the beneficiary will be responsible for all costs.
When you enroll in Beneficiary Self-Service, you can view and print your TRICARE EOB so you can access your information at any time. Remember, your EOB is a detailed statement showing what action TRICARE has taken on your claim, not an invoice. Your Tricare benefits are the same no matter where you live, but customer service contacts are different in each region. Each area is managed by a contractor to provide you with healthcare.
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If you live abroad, please visit the Tricare Service Center page to identify the point of contact in your country.
Includes: Alabama, Arkansas, Connecticut, Delaware, District of Columbia, Florida, Georgia, Illinois, Indiana, Iowa (Rock Island Arsenal area only), Kentucky, Louisiana Anna, Maine, Maryland, Massachusetts, Michigan, Mississippi, Missouri (St. Louis area), New Hampshire, New Jersey, New York, North Carolina, Ohio, Oklahoma, Pennsylvania State, Rhode Island, South Carolina, Tennessee, Texas (excluding the El Paso area), Vermont, Virginia, West Virginia, and Wisconsin
Includes: Alaska, Arizona, California, Colorado, Hawaii, Idaho, Iowa (excluding the Rock Island Armory area), Kansas, Minnesota, Missouri (excluding the St. Dana, Nebraska, Nevada, New Mexico, North Dakota, Oregon, South Dakota, Texas (southwest corner only, including El Paso), Utah, Washington, and Wyoming State
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