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DE SERVICE REQUEST WORKERS COMP LONGSHORE LIABILITY FEDERAL (Please choose appropriate service/s) Complete MSA Allocation Report Only (Allocation report with Submission) Lien Research Reopen Update **Date of Last report: Date Referred CASE INFORMATION Claimant Name (First, Middle Initial, Last) Date of Birth Address Date of Injury City State Zip Code Jurisdictional State Employer Social Security Number Claim Number KEY CONTACT & BILLING INFORMATION (please choose referring.

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What is TRICARE? TRICARE is the uniformed services health care program for active duty service members (ADSMs), active duty family members (ADFMs), National Guard and Reserve members and their family members, retirees and retiree family members, survivors, and certain former spouses worldwide.

MSA is comprised of the cycle of billing and the collections of funds for medical services received at a MTF. MSA prepare and complete a financial record of transactions, which include collections, accounts receivable, and deposits.

Mission subsistence allowance (MSA) is a daily allowance payable by the Organization for living expenses incurred by staff members in the field in connection with their temporary assignment or appointment to a special mission*.

The Tricare Management Activity contracts with several large health insurance corporations to provide claims processing, customer service and other administrative functions to the Tricare program.

What is Tricare? Tricare is the U.S. military's health care program and functions as government-managed health insurance. Tricare's various coverage plans provide health care for millions of current and former service members and their families. Tricare is managed by the Pentagon's Defense Health Agency.

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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