MHS GENESIS is the Military Health System's modern electronic health record that provides a single health record for service members, veterans, and their families. It goes to the MHS GENESIS Patient Portal, which replaced the TRICARE Patient Portal, is a secure website for 24/7 access to your health information, including managing appointments, exchanging messages with your care team and now supports prescription refill requests online.
By TRICARE Communications NEWS | Jan 30, 2023
FALLS CHURCH, Va. – Do you need to file a TRICARE Overseas claim for medical care or prescriptions you received overseas? If so, it’s important to understand the different TRICARE Overseas claim submission methods available to you.
“There’s more than one way to submit a TRICARE claim overseas,” said Michael Griffin, program analyst with the TRICARE Overseas Program Office at the Defense Health Agency. “Choosing the quickest method to submit your claim and knowing what information you may need to provide can help ensure you get your claim processed in a timely manner.”
Medical Claims
You can submit your claim directly the TRICARE Overseas Program (TOP) claims processor. There are three options.
1. TRICARE Overseas Secure Claims Portal
The TRICARE Overseas Secure Claims Portal is the fastest and most secure way to submit a claim. You can use the wizard, which helps guide you through the process. This ensures the claims processor receives your claim instantly and enters it directly into the claims processing system. You can also submit your claim via secure messaging through the portal. This is slightly slower, as your claim is entered into the system manually.
There are other benefits of using the portal, as detailed in this claims video. You can:
You must first register to use the portal. To learn how to register for and use the portal, check out the tutorial videos.
2. Secure Fax
Using secure fax is another quick way to submit a claim. Fax your claim to +1-608-301-2251. Your claim is considered received on the same day of submission.
3. Overseas Postal Mail
Using postal mail is the least timely way to submit a claim and receive reimbursement. Because overseas-to-U.S. mail delivery timelines vary, delivery can take up to 28 days.
To help ensure that WPS processes your TRICARE Overseas claim in a timely manner once received, be sure to fully complete and sign the claim form (DD Form 2642). Remember to include the following required information:
To find the mailing address you should use, go to TOP Claims Mailing Addresses.
Allow up to 30 days for WPS, the claims processor, to process your TRICARE Overseas claim after they receive it. In some cases, they may ask you to send additional information to determine benefit coverage to complete processing of the claim. After your claim is processed, it may take up to 28 days to receive your reimbursement in the mail.
Pharmacy Claims
Do you need to file a claim for your prescription? This depends on where your prescription was filled. As noted in the TRICARE Pharmacy Program Handbook, you don’t need to file a claim if your prescription was filled at a military pharmacy, through TRICARE Pharmacy Home Delivery, or at a TRICARE retail network pharmacy.
If your prescription was filled at a non-network pharmacy, you’ll need to file a claim to get reimbursed for covered prescription drugs. For prescriptions filled at non-network pharmacies in the U.S. or the U.S. territories of American Samoa, Guam, the Northern Mariana Islands, Puerto Rico, or the U.S. Virgin Islands, Express Scripts is the pharmacy contractor to send your claim. For prescriptions filled outside the U.S. and U.S. territories, submit your claim to WPS.
You can do this either online through the secure claims portal or by mail. Be sure to submit proof of payment with your overseas pharmacy claims. If you’re in the Philippines, you must get your prescription filled at a TRICARE-certified pharmacy to ensure your claims are reimbursed. Visit Pharmacy Claims to learn more about filing claims.
Deadlines to File Claims
The deadline to file a claim depends on when and where you received care. For care in the U.S. and U.S. territories (American Samoa, Guam, the Northern Mariana Islands, Puerto Rico, and the U.S. Virgin Islands), you have one year from the date of service or discharge to submit a claim. For overseas care, you have three years. The currency exchange rate is determined by the last date of service or discharge for an inpatient admission.
For more information on how to file your TRICARE Overseas claim, check the TOP website. If you have questions or need help, you can contact your TOP Regional Call Center.
John Letow, The TRICARE Guy, provides exhaustively researched and documented information of the entire TRICARE system. Extensive cross references to official government sources so you can drill down in great detail to learn the ins and outs of using TRICARE.
TRICARE Around The World on Facebook
TRICARE In The Philippines on Facebook
The Tricare program is managed by the Defense Health Agency. Before 1 October 2013, it was managed by the Tricare Management Activity under the authority of the Assistant Secretary of Defense (Health Affairs). On that date, it was disestablished and TRICARE responsibility was transferred to the newly established Defense Health Agency.
Historically, health care for military personnel and their dependents was provided in military medical facilities as promised by the military, and through a referral system, by civilian medical personnel where military physicians were not available in a certain specialty, or when and where overcrowding of a military medical facility occurred.
Active duty military personnel always have priority for care in military medical facilities. After World War II and the Korean War, especially with the growth in the standing forces of the U.S. military due to the Cold War, access to care in military facilities became increasingly unavailable for military retirees and the dependents due to resource constraints and growing demands on the system. It was at this time that the concept of "space-available basis" (Space) for military retirees and military dependents was first noted. To address this problem, Congress passed the Dependents Medical Care Act of 1956 and the Military Medical Benefits Amendments of 1966. These acts allowed the Secretary of Defense to contract with civilian health care providers. This civilian health care program became known as the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) in 1966.
In the late 1980s, because of escalating costs, paperwork demands, and general beneficiary dissatisfaction, DoD initiated a series of demonstration projects. Under a program known as the CHAMPUS Reform Initiative, a contractor provided both health care and administrative-related services, including claims processing. The Tricare Reserve Retired project was one of the first to introduce managed care features to the CHAMPUS program. Beneficiaries were offered three choices – a health maintenance organization-like option called Tricare (CHAMPUS) Prime that required enrollment and offered enhanced benefits and low-cost shares, a preferred provider organization-like option called Tricare (CHAMPUS) Extra that required use of network providers in exchange for lower cost shares, and the standard CHAMPUS option that continued the freedom of choice in selecting providers but required higher cost shares and deductibles known as Tricare Standard.
Although DOD's initial intent under the CHAMPUS Reform Initiative was to award three competitively bid contracts covering six states, only one bid, made by Foundation Health Corporation (now Health Net) covering California and Hawaii, was received. Foundation delivered services under this contract between August 1988 and January 1994.
TRICARE is BORN: In late 1993, in response to requirements in the DOD Appropriation Act for Fiscal Year 1994, the DoD announced plans for implementing a nationwide managed care program for the MHS that would be completely implemented by May 1997. Under this program, known as Tricare, the United States was divided into 12 health care regions. An administrative organization, the lead agent, was designated for each region and coordinated the health care needs of all military treatment facilities in the region. Under Tricare, seven managed care support contracts were awarded covering DOD's 12 health care regions.
Since then, TRICARE has undergone several restructuring initiatives, including re-alignment of contract regions, Base Realignment and Closure, and the addition of "Tricare for Life" benefits in 2001 for those who are Medicare-eligible, and "Tricare Reserve Select" in 2005.
GOOD READS:
July 18, 2024
This is kind of irrelevant for Korea, but we will mention it anyway. When searching for a doctor, you may come across the terms “network provider” or “non-network provider.” If in the states understanding these two provider types matters, but here in the overseas world not so much. In fact not at all, UNLESS you are in the Philippines. Read more about the two types on the TRICARE website undernetwork provider or non-network provider. In addition, there is also a term called Authorized Provider, but here too, in the overseas world (except the Philippines), this is not relevant.
Why "UNLESS you are in the Philippines"? In the Philippines, you need to see a preferred provider or a certified provider. Use the Philippine Provider Search Tool to locate a provider near you.
TRICARE Regional Beneficiary Center Korea
USAG Humphreys One-Stop Bldg
DSN: 737-1433 / COMM: 05033-37-1433
TRICARE Office Brian G. Allgood Army Hospital, Korea
USAG Humphreys Hospital Bldg 3031
DSN: 737-1437 / COMM: 05033-37-1437
TRICARE Office 51st Medical Hospital, Korea
Osan AB Hospital
DSN: 784-2273 / COMM: 0505-784-2273
Money-saving tip: When calling internationally, use Skype or similar app on your smartphone or computer. With Skype, U.S. toll-free numbers are free and international numbers are just pennies per minute.
