About TRICARE
TRICARE is the health care program for uniformed service members, retirees, and their families worldwide. TRICARE is managed by the Defense Health Agency (DHA) and administered through regional contractors. TRICARE offers several plan options including TRICARE Prime (HMO), TRICARE Select (PPO), and TRICARE For Life (Medicare supplement for retirees).
How fast does TRICARE pay?
TRICARE processes clean claims within 30 days per the Prompt Payment Act. TRICARE For Life claims, which coordinate with Medicare, may take additional time for coordination processing.
Common denial and billing issues.
- Provider not TRICARE authorized (must be specifically credentialed)
- Referral required for TRICARE Prime beneficiaries not obtained
- TRICARE For Life claims must bill Medicare first
- Active duty vs. retiree vs. dependent billing rules differ
- International claims processed through different systems
- Authorization for specialty services not obtained
Prior authorization requirements.
TRICARE Prime requires referrals from a Primary Care Manager (PCM) for specialty care. TRICARE Select allows self-referrals to network providers. All providers must be TRICARE-authorized to bill TRICARE.
How Copay works with TRICARE.
TRICARE claims from TRICARE-authorized providers are eligible for Copay purchase. TRICARE's 30-day clean claim standard is reliable, but Copay accelerates payment to the next business day for eligible TRICARE claims.
Stop waiting on TRICARE.
Eligible claims are purchased and funded the next business day.