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The document is a TRICARE DoD/CHAMPUS Medical Claim form, which serves as a patient's request for medical payment. It outlines the necessary information and documentation required for processing claims, including details about the patient's condition, provider information, and any other health insurance coverage. The form emphasizes the importance of accuracy and completeness to avoid delays in payment and includes instructions on how to fill it out correctly.

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Versions	Form popularity	Fillable & printable
2018	4.8 Satisfied (116 Votes)
2007	4.4 Satisfied (270 Votes)
2003	4 Satisfied (30 Votes)
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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Does TRICARE accept electronic claims?

A: A reimbursement is the money TRICARE pays back to you if you paid your provider out of pocket. Remember, if you pay up front for services, be sure to get a receipt so you can include it with your claim.

How do I submit my TRICARE claim?

If you live in the U.S., District of Columbia, Puerto Rico or U.S. Territories, you have 1 year from the date of service or inpatient discharge to file your medical claim. If you live overseas, you have 3 years from the date of service or inpatient discharge to file your medical claim.

How long does a TRICARE member have to file a medical claim?

Electronic Claims Submission TRICARE network providers must file 100 percent of their TRICARE claims electronically. * We encourage non-network providers to take advantage of this feature as well. Save time and money. Electronic claims are faster than paper claims, so you get paid faster.

Can I submit my own claim to TRICARE?

A: As detailed in the TRICARE Choices in the United States Handbook, youll need to file your own claims when you: See nonparticipating providers: If you see a non-network TRICARE-authorized provider who chooses not to participate on your claim, youll need to file a claim to get reimbursed for your expenses.

How do I submit a receipt to TRICARE for reimbursement?

Medical Claims Step 1: Fill out the TRICARE claim form. Download the Patients Request for Medical Payment (DD Form 2642). Step 2: Include a copy of the providers bill. Attach a readable copy of the providers bill to the claim form. Step 3: Submit the claim. Step 4: Check the status of your claims.

dd form 2642 fillable

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What is a DD form 2642?

TRICARE DoD/CHAMPUS Claim Form - Patients Request for Medical Payment (DD Form 2642) Beneficiaries filing their own medical claims must use this form to receive reimbursement from the TOP Claims Processor for TRICARE Covered Services. Note: TRICARE Overseas beneficiaries must submit proof of payment with all claims.

What happens when TRICARE denies a claim?

Services and supplies considered for coverage by TRICARE, if denied, are subject to the factual appeal process. Services and supplies denied payment by Medicare will not be considered for coverage by TRICARE if the Medicare denial of payment can be appealed through the Medicare appeals process.

Get the up-to-date dd form 2642-2025 now

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Got questions?

Does TRICARE accept electronic claims?

How do I submit my TRICARE claim?

How long does a TRICARE member have to file a medical claim?

Can I submit my own claim to TRICARE?

How do I submit a receipt to TRICARE for reimbursement?

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What is a DD form 2642?

What happens when TRICARE denies a claim?

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