Tricare for life skilled nursing facility authorization request form 2026

1. Click ‘Get Form’ to open the TRICARE® for Life Skilled Nursing Facility Authorization Request Form in our editor.
2. Begin by filling out the Provider Information section. Enter the facility name, address, contact person, and their telephone number. Ensure all fields are completed accurately.
3. Next, move to the Patient Information section. Input the TRICARE 9 Digit Veteran Sponsor Number, names of both the veteran and patient, and their date of birth. Include the patient's address and indicate if another insurance is involved.
4. In the Requested Service Information section, provide details about the qualifying hospital stay dates and Medicare coverage end date. Enter the start date for TRICARE® for Life authorization and include the ICD 10 Diagnosis Code.
5. Review all sections to ensure completeness. Attach any required supporting documentation as specified in the instructions before submitting your form.

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