TRICARE: Timely Filing, Appeals, and Billing Guide
TRICARE is the health program for US uniformed service members, retirees, and their families, administered under the Defense Health Agency through regional managed-care contractors. Claims must generally be filed within one year of the date of service (or discharge for inpatient), and appeals follow federal TRICARE rules rather than a private-payer contract.
- Type
- Federal military health program (DHA)
- Timely filing
- 1 year from DOS (discharge if inpatient)
- Appeal deadline
- Federal TRICARE process (per contractor)
- Portal
- Regional contractor portal (TriWest / Humana Military)
What is TRICARE?
TRICARE is the health-care program of the US military, covering active-duty service members, National Guard and Reserve, retirees, and their families worldwide. It is run by the Defense Health Agency (DHA) and delivered through regional managed-care support contractors that process claims and manage provider networks.
Plan options include TRICARE Prime (HMO-style, requires referrals), TRICARE Select (PPO-style), and TRICARE For Life (the Medicare wraparound for eligible retirees). Each has different referral and cost-share rules.
What are TRICARE\'s timely filing and appeal deadlines?
File within one year of the date of service, or one year of the discharge date for inpatient care. Appeals follow the federal TRICARE process administered by the regional contractor, not a private-payer contract clause.
Where do you submit TRICARE claims?
Submit to the managed-care support contractor for the region where care was delivered — historically Humana Military (East) and TriWest (West), though DHA re-competes these contracts. Use that contractor's payer ID through your clearinghouse and its portal for status and appeals.
Because TRICARE is usually the payer of last resort, resolve coordination of benefits first when the patient has other coverage; TRICARE For Life pays after Medicare.
What billing quirks should you watch?
- Region matters. Bill the correct regional contractor for the care location.
- Prime referrals are strict. No referral means point-of-service or denial.
- Payer of last resort. Other health insurance pays first (except Medicaid).
- Contractors change. Verify the current East/West contractor — see Humana, which has held military contracts.
Frequently asked questions
TRICARE generally requires claims within one year of the date of service, or within one year of the discharge date for inpatient care. This is a federal rule, not a negotiated contract term. TRICARE does publish a waiver process for filing beyond the deadline in limited circumstances, but the default one-year window applies to most claims.
TRICARE is split into regions administered by managed-care support contractors — historically Humana Military in the East and TriWest in the West, though contracts change. You submit to the contractor for the region where care was delivered, using its payer ID and portal. Verify the current regional contractor, because DHA re-competes these contracts periodically.
TRICARE is generally the payer of last resort after other health insurance (with narrow exceptions like Medicaid). If a patient has employer coverage, bill that first and submit to TRICARE with the primary EOB. TRICARE For Life wraps around Medicare for eligible retirees, paying as secondary after Medicare processes the claim.
Sources & further reading
Reviewed by the ImmediCare Solutions RCM team
Certified billers and coders handling claims across 50+ specialties nationwide. This entry is reviewed against current payer policy and CMS rules. Last review: Jul 5, 2026.
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