TRICARE Overseas Claim Rejected or Denied: What to Do Next

Do not give up on a rejected claim. Many are fixable, and TRICARE gives you some time to fix them.

Step 1: Find out which it is

• Returned: something was missing or unreadable. Fix it and resubmit.
• Denied: a decision was made. The EOB should print a reason.

Step 2: Read the reason

Match the reason to the usual causes:

Reason	Fix
Unsigned form	The form says it will be returned. Sign it with a physical wet signature or a CAC signature. See the form guide.
No itemized bill	Get a detailed invoice on the provider’s letterhead. See bill requirements.
No proof of payment	Add a card receipt, bank statement or PAID-stamped bill. See proof of payment.
No narrative	Add a description of the reason for the medical services. Block 8a on the form must be completed on every claim.
Missing sponsor SSN or DBN	Add it to block 10 of the form. The form’s reminder list also asks for the patient’s name, the sponsor’s name and the sponsor’s SSN or DBN on the attachments, so write them on your copies.
Other insurance not shown	Add the other insurer’s EOB. The form says the claim cannot be processed until the other insurance information is provided. See other health insurance.
Accident or work related	Add DD Form 2527. See injury claims.
Unreadable or rejected file	Rescan, and check that the file is not password-protected.

Step 3: Check the deadline

The DD Form 2642 says that if a claim is returned for additional information, you must resubmit within the filing deadline, or within 90 days of the notice, whichever date is later. Note the date on the notice the day you get it. See the filing deadline guide.

Step 4: Resubmit or appeal

For a returned claim, resubmit with the missing item. For a denial you disagree with, TRICARE says you can appeal certain decisions, and that the appeal must be filed within 90 days of the date of the EOB notice. Contact your regional call center with the claim number if you need help.

How PaidTrail helps

PaidTrail’s checklist catches most of these before you file, and when you add an EOB it shows each denial reason next to the exact words printed, plus the appeal date only when the EOB states one.