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Submit a Beneficiary Claim

Network providers must submit claims for all TRICARE beneficiaries, and most non-network providers submit TRICARE claims. If you receive care from a non-network provider who does not submit TRICARE claims, you may submit a beneficiary claim.

What to Include in the Claim

TRICARE Beneficiary Claim Form DD2642

  • Complete all boxes on the form.
  • Be sure to list your medical condition(s) (diagnoses) in Box 8a. If the provider's itemized bill does not include your diagnoses and the information in this box does not describe your medical condition(s) the claim cannot be processed.
  • Sign the claim form.
  • Make a copy of everything submitted for your records.
  • The claim must be submitted within one year of the date you received care.
  • Only one beneficiary can be listed on each claim form.
  • To simplify processing, submit separate claims for different providers.

Itemized Provider Bill 

The itemized provider bill must be on the provider's letterhead and include:

  • beneficiary's name,
  • date of each service,
  • procedure code or description of each service,
  • billed amount for each service,
  • provider's name if services were received from an individual provider (circle provider's name if from a group or clinic with several provider names on the bill), and
  • provider's address.

Other Health Insurance (OHI) Explanation of Benefits (EOB)

  • If you have OHI, it is primary to TRICARE (Exceptions: state Medicaid programs, state Victims of Crimes programs, Indian Health Services and TRICARE supplement plans).
  • Be sure there is a matching EOB for each charge on the provider's bill.
  • If your OHI denied a charge as a duplicate you will need to include the originally processed EOB for the same service.
  • If your OHI denies a service as not medically necessary you will need to appeal to your OHI before TRICARE can consider the claim.
  • See additional information about how TRICARE works with OHI.

Where to Send the Claim 

TRICARE Medical Claims

Health Net Federal Services, LLC
c/o PGBA, LLC/TRICARE
PO Box 202112
Florence, SC 29502-2112

TRICARE Pharmacy Claims

TRICARE Pharmacy Claims
Express Scripts
PO Box 52132
Phoenix, AZ 85072