Get Humana Military Form Dd 2642

Filling out the Humana Military Form DD 2642 is an essential step for users seeking reimbursement for medical services covered by TRICARE. This guide provides clear instructions to help you complete the form online with ease and confidence.

Follow the steps to fill out the Form DD 2642 accurately.

1. Click ‘Get Form’ button to obtain the form and open it in your preferred editor.
2. Begin by entering the patient's name in the designated field, ensuring it matches the name on the identification documents.
3. Provide the sponsor’s Social Security number (SSN) or Department of Defense Benefits Number (DBN). Eligible former spouses should input their own SSN or DBN instead of the sponsor's.
4. Enter the provider’s name and address. If the itemized bill includes multiple providers, circle the name of the actual service provider.
5. Detail each service or supply received by the patient, including the description and corresponding charges in the appropriate fields.
6. If a diagnosis is necessary and is not included on the bill, complete block 8a on the form.
7. Attach a readable copy of the itemized provider's bill to support your claim, ensuring it includes all relevant details.
8. Review all entered information for accuracy and completeness, making any necessary corrections.
9. Save your changes, and then you can choose to download or print the completed form for submission.
10. Share the form with the appropriate claims processor for your region based on your location.

Complete your forms online today for a streamlined submission process.