Get Tp-1568.6 2013-2025

The TP-1568.6 is a vital form for documenting noncovered services under the TRICARE program. This guide will provide you with clear, step-by-step instructions to help you complete the form online.

Follow the steps to successfully fill out the TP-1568.6 form online.

1. Click the ‘Get Form’ button to access the TP-1568.6 form and open it in your preferred digital editing tool.
2. Enter the sponsor's name in the appropriate field. Ensure that the name matches the records to prevent any discrepancies.
3. Fill in the sponsor ID, which is usually assigned by TRICARE. This ID is crucial for identification purposes.
4. Provide the patient's name as it appears in their official documents. Accuracy is important for proper identification.
5. Input the patient ID, similarly assigned by TRICARE, to establish patient identification.
6. Enter the description of the service being requested, making sure to be clear and concise.
7. Fill out the procedure details that relate to the noncovered service, including the name of the procedure.
8. Specify the approximate cost associated with the noncovered services. This should be an estimate provided by the provider.
9. Input the diagnosis related to the procedure. This should reflect the reason for the noncovered service.
10. Document the date of service when the procedure is to be performed or was performed.
11. Fill in the provider's name who is rendering the service.
12. Input the Tax Identification Number (TIN) of the provider.
13. Provide the address of the service provider to ensure proper documentation.
14. Include the physician's signature, affirming that they understand the noncovered status of the services.
15. After completing the form, save the changes. You may download, print, or share the TP-1568.6 form as needed.

Complete your TRICARE documents online for a smooth experience.