Claims

Claims

Q16:

I am not seeing my claims in the TRICARE portal. Why?

A:

The claim(s) have not been submitted to TRICARE by your provider/hospital. If they need further assistance have them contact your correct regional contractor.

Q17:

I am on Line of Duty plus I have TRICARE Reserve Select. Why are the claims paid as TRS?

A:

The Defense Enrollment Eligibility and Reporting System does not reflect LOD so claims will default to TRS instead of your LOD and/or pre-authorization. If there is a cost-share/copayment associated with that claim, have your unit contact us so we can direct TRICARE to remove the copayments.

Q18:

I am a Reservist with a Dental Line of Duty. What do I do?

A:

Defense Health Agency, Great Lakes does not handle dental claims. All dental claims and Line of Duty information must be routed through United Concordia, at:

United Concordia ADDP Authorization
P.O. Box 69431
Harrisburg, PA 17106-9431

Q19:

How long does it normally take to process my claims?

A:

TRICARE has 30 business days (excluding weekends and holidays). You can track the status on your region’s beneficiary website.

Q20:

TRICARE paid my claims, but I am still getting bills from the providers. What can I do?

A:

Pull a copy of your Explanation of Benefits and contact provider’s billing office about it. If that does not resolve the issue, contact your TRICARE regional contractor and request balance billing letter(s) be sent to the provider.

Q21:

Why is TRICARE requesting refund of payment?

A:

Defense Health Agency, Great Lakes is not involved in recoupments. Please contact your TRICARE regional contractor. You can also contact the TRICARE Health Plan Customer Service Line at 844-204-9351, option 6, for assistance.

Q22:

My provider is unwilling to submit my claims to TRICARE. What do I do?

A:

Please note that  Defense Health Agency, Great Lakes/Military Medical Support Office has no authority to contact private sector providers and direct them to file TRICARE Line of Duty Claims. Contact your regional contractor and request to speak with claims. They should assist on getting providers to bill.

Q23:

Why can’t my provider submit a claim?

A:

Sometimes providers are uncomfortable submitting electronically if the Defense Enrollment Eligibility and Reporting System says you are ineligible for care. If they are unable to submit electronically, then they need send claims to TRICARE via fax or mail using a CMS 1500 form or a UB04 form. These are official insurance claim forms that must be completed by the provider’s office ONLY. 

The provider can manually enter the member’s information: name, sponsor ID/SSN, address, and phone number.

For more information the provider can contact TRICARE directly.

East Region: https://www.humanamilitary.com/provider/

West Region: https://tricare.triwest.com/en/provider/

Q24:

How can I get reimbursed for claims I paid out-of-pocket?

A:

Defense Health Agency, Great Lakes does not reimburse. You must have the provider bill TRICARE and once providers receive payment from TRICARE, it is up to the provider’s office to refund you anything out-of-pocket. 

Additionally, you can submit a claim for reimbursement to TRICARE by going to https://www.tricare.mil/FormsClaims/Claims for more information.

Q25:

The provider billed my private insurance instead of TRICARE. What do I do?

A:

You must have your provider bill TRICARE. Once your provider receives payment from TRICARE, it is up to the provider’s office to refund your private insurance for any payments made on your behalf.

Q26:

I have dual eligibility; I am a TRICARE Prime dependent and a Reservist with Line of Duty. Why are my claims denied?

A:

If you have a Line of Duty, the provider must bill under your own SSN/DBN/DoDID. Line of Duty claims cannot be reprocessed under the incorrect SSN. Authorization is only valid for the Line of Duty condition and if doesn’t match it will be denied.

Q27:

I am getting bills for my Periodic Health Assessments. Why aren’t you paying it?

A:

Defense Health Agency, Great lakes cannot process Periodic Health Assessments as eligibility/Line of Duty care. Learn more: https://www.health.mil/Military-Health-Topics/Health-Readiness/Reserve-Health-Readiness-Program

Q28:

I received a debt collection notice. What do I do?

A:

First, register for your regional contractor’s beneficiary portal to check if the claim(s) have been submitted to TRICARE. If the claim is in the portal, your unit can contact us to authorize TRICARE to reprocess the claim(s). If the providers have not billed TRICARE, you should provide them TRICARE’s billing information. If further issues persist, you can fill out a debt collection package located on our main website and in our process guide.

Q29:

I have multiple LOD claims for the same amount, but only one was paid.

A:

Please contact TRICARE for claims and provider concerns.

  • TRICARE East (Humana Military) - 800-444-5445
  • TRICARE West (TriWest Healthcare Alliance) - 888-874-9378

Q30:

If DHA-GL denies my eligibility or follow up care, how do my claims get paid?

A:

DODI 1241.01 (Page 2) states how the medicals bills can get paid if denied, “Financial adjustments will be made so that the costs of the emergency medical care are paid by the member, member’s health insurance plan, any other third-party payer”.

If you're having trouble finding what you're looking for, consider using fewer words in your search criteria. Results are limited to content that matches all terms in the search field.

<< < 1 2 > >> 
Showing results 16 - 30 Page 2 of 2