Fill out DD-2642 (TRICARE Medical Claim) online
DD Form 2642 is used by TRICARE beneficiaries to file medical claims and request reimbursement when their healthcare provider does not file a claim on their behalf. Common scenarios include receiving care while traveling, getting care from a non-participating provider, or filing overseas claims.
How to fill out DD-2642 (TRICARE Medical Claim)
Enter the patient information
Provide the patient's name, date of birth, sponsor's Social Security Number or DoD ID number, and the TRICARE beneficiary category (active duty family member, retiree, etc.).
Describe the medical services
List each medical service received, including the date of service, type of service, provider name and address, diagnosis, and the amount charged.
Indicate other health insurance
If the patient has other health insurance (OHI) in addition to TRICARE, provide the insurance company name, policy number, and what amount was paid by the other insurance.
Attach supporting documents and sign
Attach the itemized bill on the provider's letterhead, proof of payment, and any Explanation of Benefits (EOB) from other insurance. Sign and date the form.
About DD-2642 (TRICARE Medical Claim)
Who needs this form
TRICARE beneficiaries (active duty family members, retirees, and their dependents) who paid out of pocket for covered medical services and need to request reimbursement from TRICARE.
Where to submit
Submit to the appropriate TRICARE claims processor. In the US and US territories, claims must be filed within one year of the date of service or inpatient discharge. Include an itemized bill on the provider's letterhead and proof of payment.
Source and content freshness
- Filing deadlines may shift for weekends and holidays. Verify due dates with official instructions.
Common mistakes to avoid
- Not including an itemized bill on the provider's letterhead
- Missing the one-year filing deadline from the date of service
- Not including proof of payment (receipt or cancelled check)
- Filing a claim for services that should have been filed by the provider directly
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When should I use DD-2642 instead of having my provider file directly?
Use DD-2642 when your provider cannot or will not file a claim with TRICARE directly. This commonly happens when you receive care from a non-network provider, receive emergency care while traveling (especially overseas), or pay out of pocket at a provider who does not participate in TRICARE. If your provider is a TRICARE network provider, they should file the claim directly.
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