Get Lc-7363-0 Tricare Statement Of Claim & Auth To Release ... - Ebview

Filling out the LC-7363-0 TRICARE Statement Of Claim & Auth To Release is essential for processing your health insurance claims efficiently. This guide provides clear, step-by-step instructions to help users of all backgrounds complete the form accurately and confidently.

Follow the steps to complete your TRICARE claim form online

1. Click ‘Get Form’ button to access the LC-7363-0 form and open it in your preferred editor.
2. Fill in Section 1, which includes the claimant's statement. Provide your insurance number, full name, date of birth, and contact information. Ensure only one patient is listed per form.
3. Complete Section 2 only if you want the insurance benefits paid directly to your healthcare provider. Include their name, telephone number, and address.
4. Attach a copy of your TRICARE Explanation of Benefits form and include your certificate number on the copy for claims related to TRICARE Supplements.
5. If seeking benefits under the Hospital Income Plan, ensure to include a copy of the hospital bill that shows your admission and discharge dates.
6. After filling out all required sections, sign and date the form on the designated area provided on the back.
7. Once complete, mail the form to the Reserve Officers Association at the following address: P.O. Box 10403, Des Moines, IA 50306-0403.
8. Make sure to keep a copy of the completed form and any attachments for your records.

Start completing your documents online to ensure your claims are processed smoothly and efficiently.