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Click ‘Get Form’ to open it in the editor.
In Part I, select the reason for submission: whether it's a new EFT authorization, a revision, or a termination request.
Proceed to Part II and enter your provider or supplier information. Fill in your name, legal business name, and tax identification number accurately.
In Part III, provide depository information. Enter your bank's name, account holder’s details, and routing number. Ensure all fields are completed to avoid processing delays.
Complete Part IV by entering the contact person's information responsible for this agreement.
Finally, sign and date the authorization in Part V to certify that all provided information is correct and that you have sole control of the account.
Start filling out your TRICARE for Life EFT Enrollment form online today for free!
Fill out tricare for life eft enrollment online online It's free
You dont pay any enrollment fees for TFL, but you must pay Medicare Part A and Medicare Part B monthly premiums. Medicare Part A is paid from payroll taxes while you or your spouse are working. Your Part B premium is based on your income.
Where to bill TRICARE for life?
Claims Filing Addresses East RegionTRICARE East Region Claims P.O. Box 202146 Florence, SC 29502-2146 East Region Claims TRICARE For Life (U.S. U.S. territories) WPS TRICARE For Life P.O. Box 7890 Madison, WI 53707-7890 .TRICARE4u.com5 more rows Aug 19, 2025
What is TRICARE Wests main phone number?
Medical and General TRICARE West Region (TriWest Healthcare Alliance)General Questions: 888-TRIWEST (874-9378) TRICARE East Region (Humana Military) 800-444-54453 more rows
How do I enroll in TRICARE online?
For complete information regarding TRICARE eligibility and coverage, please visit the Plans page on the TRICARE Web site. To enroll in TRICARE, sign into milConnect and select Beneficiary Web Enrollment (BWE) from the Benefits menu.
How do I contact TRICARE West provider enrollment?
Call us at 1-888-TRIWEST (874-9378) and follow the prompts for expert service.
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What is the phone number for TRICARE West EFT enrollment?
Call Us Regional ContractorsPhone Number TRICARE East Region Humana Military 800-444-5445 8 a.m. to 6 p.m. ET and CT, MondayFriday TRICARE West Region TriWest Healthcare Alliance 888-TRIWEST (874-9378) 8 a.m. to 6 p.m. in your time zone (CT, MT, PT, Alaska Time, and Hawaii-Aleutian Time), excluding federal holidays1 more row
What number is 800-444-5445?
If you are a TRICARE network provider or want to become a network provider, contact your local provider representative or call (800) 444-5445.
How do I contact TRICARE enrollment?
Step 1: Enroll in TRICARE Select Online1Go to milConnect. Click the Benefits tab. Click Beneficiary Web Enrollment. Phone Call your regional contractor: East RegionHumana Military: 800-444-5445 West RegionTriWest Healthcare Alliance: 888-874-93781 more row Aug 18, 2025
Related links
TRICARE For Life
TRICARE For Life is Medicare-wraparound coverage if youre TRICARE-eligible and have Medicare Part A and Part B, regardless of age or place of residence.
Dec 18, 2024 New submitters must file a Trading Partner Agreement and Enrollment Form to obtain a mailbox/submitter ID; Confirm Payer ID 99727 is enabled if
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