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Get Human Military Healthcare Services Tricare Institutional Provider Application

______________ TRICARE South Region Provider Data Management P.O. Box 7039 Camden, SC 29020-7039 Fax 803-462-3986 Toll-Free: 1-800-403-3950 UB-04 “Signature on File Form” For TRICARE Claims Beginning January 1, 2008, all UB-04 paper claims submissions for TRICARE must include a signature on the claim form in order to process. The provider signature should be applied in the “Remarks Field (FL80) of the UB-04 claim form. However, if you would like to eliminate the need to apply a signatu.

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