FALLS CHURCH, VA, January 30, 2023 - Do you need to file a TRICARE Overseas claim for medical care or prescriptions you received overseas? If so, it’s important to understand the different TRICARE Overseas claim submission methods available to you.
“There’s more than one way to submit a TRICARE claim overseas,” said Michael Griffin, program analyst with the TRICARE Overseas Program Office at the Defense Health Agency. “Choosing the quickest method to submit your claim and knowing what information you may need to provide can help ensure you get your claim processed in a timely manner.”
Medical Claims
You can submit your claim directly to Wisconsin Physicians Service (WPS), the TRICARE Overseas Program (TOP) claims processor. There are three options.
1. TRICARE Overseas Secure Claims Portal
The TRICARE Overseas Secure Claims Portal is the fastest and most secure way to submit a claim. You can use the wizard, which helps guide you through the process. This ensures the claims processor receives your claim instantly and enters it directly into the claims processing system. You can also submit your claim via secure messaging through the portal. This is slightly slower, as your claim is entered into the system manually.
There are other benefits of using the portal, as detailed in this claims video. You can:
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Track the status of your claim.
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Review your payment information.
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Communicate directly with WPS, the claims processor.
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Sign up for electronic funds transfer (direct deposit) to a U.S. bank account.
You must first register to use the portal. To learn how to register for and use the portal, check out the tutorial videos.
2. Secure Fax
Using secure fax is another quick way to submit a claim. Fax your claim to +1-608-301-2251. Your claim is considered received on the same day of submission.
3. Overseas Postal Mail
Using postal mail is the least timely way to submit a claim and receive reimbursement. Because overseas-to-U.S. mail delivery timelines vary, delivery can take up to 28 days.
To help ensure that WPS processes your TRICARE Overseas claim in a timely manner once received, be sure to fully complete and sign the claim form (DD Form 2642). Remember to include the following required information:
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A clear and legible itemized bill or invoice from the provider, detailing the services rendered and the provider’s name and address.
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A narrative description of the reason for the medical services received.
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Proof of other health insurance (OHI), if applicable. If you have OHI (such as national health insurance), TRICARE is always the last payer. If applicable, include any explanation of benefits (EOB) from your OHI, outlining any payment or denial.
To find the mailing address you should use, go to TOP Claims Mailing Addresses.
Allow up to 30 days for WPS, the claims processor, to process your TRICARE Overseas claim after they receive it. In some cases, they may ask you to send additional information to determine benefit coverage to complete processing of the claim. After your claim is processed, it may take up to 28 days to receive your reimbursement in the mail.
Pharmacy Claims
Do you need to file a claim for your prescription? This depends on where your prescription was filled. As noted in the TRICARE Pharmacy Program Handbook, you don’t need to file a claim if your prescription was filled at a military pharmacy, through TRICARE Pharmacy Home Delivery, or at a TRICARE retail network pharmacy.
If your prescription was filled at a non-network pharmacy, you’ll need to file a claim to get reimbursed for covered prescription drugs. For prescriptions filled at non-network pharmacies in the U.S. or the U.S. territories of American Samoa, Guam, the Northern Mariana Islands, Puerto Rico, or the U.S. Virgin Islands, Express Scripts is the pharmacy contractor to send your claim. For prescriptions filled outside the U.S. and U.S. territories, submit your claim to WPS.
You can do this either online through the secure claims portal or by mail. Be sure to submit proof of payment with your overseas pharmacy claims. If you’re in the Philippines, you must get your prescription filled at a TRICARE-certified pharmacy to ensure your claims are reimbursed. Visit Pharmacy Claims to learn more about filing claims.
Deadlines to File Claims
The deadline to file a claim depends on when and where you received care. For care in the U.S. and U.S. territories (American Samoa, Guam, the Northern Mariana Islands, Puerto Rico, and the U.S. Virgin Islands), you have one year from the date of service or discharge to submit a claim. For overseas care, you have three years. The currency exchange rate is determined by the last date of service or discharge for an inpatient admission.
For more information on how to file your TRICARE Overseas claim, check the TOP website. If you have questions or need help, you can contact your TOP Regional Call Center.