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Understanding the TRICARE Claims Process

Whether you submit a claim form depends on the type of TRICARE program option and provider you choose to use.

TRICARE Prime/Prime Remote enrollees

  • If you use network providers, providers file claims on your behalf.
  • If you use a non-network provider or require emergent/urgent care outside your region, the provider may file claims on your behalf or require you to pay out-of-pocket and file your own paper claim for reimbursement.

When you use network providers, the providers file claims on your behalf.

TRICARE Standard
The provider may file claims on your behalf or require you to pay out-of-pocket and file your own paper claim for reimbursement.
  • Participating providers agree to accept TRICARE payment and any cost share as payment in full.
  • Non-participating providers do not agree to accept the TRICARE-determined allowable charge as the total charge for services; they can bill you up to 15% more of the TRICARE allowable charge. TRICARE will send reimbursement to you and you, in turn, pay the provider.

Your valid uniformed services ID card serves a proof of eligibility for TRICARE coverage. You are responsible for appropriate copays, cost shares, and deductibles.

Click here to select and download the proper TRICARE Claims Forms.

For general information about TRICARE, call one of the many toll-free TRICARE information lines found at the TRICARE Contact Us web page.

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