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PRIME TRAVEL BENEFIT REIMBURSEMENT REQUEST FORM TRICARE Regional Office - West 401 West A Street Suite 2100 San Diego CA 92101-7908 Phone 800 449-6408 Fax 619 231-4245 e-Mail TROW-PrimeTravel trow. Tma.osd. mil Date http //www. tricare. mil/trowest/Prime-Travel.cfm Patient Information Primary Care Manager PCM Information Patient Name Patient Date of Birth PCM Name Patient SSN PCM Address Patient Address City State City State Zip Code PCM Phone Zi.

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Questions & Answers

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Contact support

Call your regional contractor: East—Humana Military: 1-800-444-5445. West—Health Net: 1-844-866-9378. Overseas.

Medical Claims Fill out the TRICARE Claim Form. Download the Patient's Request for Medical Payment (DD Form 2642). ... Include a Copy of the Provider's Bill. Attach a readable copy of the provider's bill to the claim form, making sure it contains the following: ... Submit the Claim. ... Check the Status of Your Claims.

TRICARE will reimburse the actual costs of lodging (including taxes) and the actual cost of meals (including taxes and reasonable tips but excluding alcoholic beverages) up to the government maximum per diem allowance for the specialty care provider's area.

TRICARE will reimburse you for TRICARE-covered services at the TRICARE allowable amount. This amount won't include any copayments, cost-shares, or deductibles. There are special rules for filing claims if you're involved in an accident with possible third-party liability.

A claim may be denied for several reasons. Many times it's a simple error that you (if you submitted the claim) or your provider made when submitting the claim. See Claim Filing Tips for a list of common mistakes. If your claim is unpaid or denied, contact your claims processor.

Claim Filing Addresses TRICARE For Life. P.O Box 7890. Madison, WI 53707-7890. 1-866-773-0404. West Claims. P.O. Box 202112. Florence, SC 29502-2112. 1-844-866-9378. East Claims. P.O. Box 7981. Madison, WI 53707-7981. 1-800-444-5445.

What is the Prime Travel Benefit? The Prime Travel Benefit reimburses reasonable travel expenses. This includes mileage, meals, tolls, parking, lodging, local transportation, and tickets for public transportation. for a qualified trip by a TRICARE Prime enrollee.

Using Select Step 1: Find a Doctor. Once enrolled, you can visit any TRICARE-authorized provider. ... Step 2: Make an Appointment. Schedule an appointment with any provider. ... Step 3: Pay for the Care. If you visit a network provider, you will only need to pay your cost-share.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232