TRICARE East (Humana Military)

Source: https://www.esd.whs.mil/Portals/54/Documents/DD/forms/dd/dd2642.pdf

Read date: 10-09-2026

Research steps

1. Download the current Patient's Request for Medical Payment, DD Form 2642, and fill all 12 blocks. The official current public PDF returned HTTP 403 on the read date, so its fillability and hash are NOT PUBLISHED. TRICARE medical claim instructions official DD forms inventory
2. Sign block 12a using a Common Access Card digital signature or a physical signature and date block 12b. An unsigned claim is denied. TRICARE medical claims
3. Attach a readable itemized provider bill with the sponsor identifier, provider name and address, service details, charges, diagnosis, and applicable other-insurance EOB. Add proof of payment if already paid. TRICARE medical claims East Region claim FAQ
4. Portal upload NO for a domestic East Region claim. TRICARE publishes online medical-claim submission only for overseas claims. The East Region public route for domestic member claims is offline, and destination details are excluded. TRICARE medical claims
5. File within one year after the date of service or inpatient discharge. Check processed claims and EOBs through Humana Military beneficiary self-service or the mobile app. TRICARE East claims East Region claim FAQ

Filing facts

• Portal upload: NO
• Portal: Humana Military beneficiary self-service
• Portal path: NOT APPLICABLE: domestic East Region member claims are submitted offline; online claim submission is published only for overseas claims
• Mail address: TRICARE East Region Claims, P.O. Box 202146, Florence, SC 29502-2146
• Fax: NOT PUBLISHED
• Attach: Sponsor DOD ID number or DBN; provider name; provider address; NPI if available; date of each service; place of each service; description of each service or supply; charge for each service; diagnosis; procedure codes; proof of payment if paid; other health insurance EOB when applicable
• File types: NOT APPLICABLE
• File size limit: NOT APPLICABLE
• Maximum files: NOT APPLICABLE
• One file or separate files: NOT APPLICABLE
• Confirmation: NOT PUBLISHED
• Status check: Humana Military beneficiary self-service or mobile app for processed claims and EOBs
• Processing time: Up to 90 days from receipt
• Member deadline: Within one year of date of service or inpatient discharge
• Deadline basis: Three years for overseas claims; East domestic therapy claim uses the one-year rule
• Mental health route: Humana Military administers East Region claims, including mental health member claims
• Provider on file: YES: the provider must submit certification paperwork to become TRICARE-authorized; the claim is denied if the provider was not authorized on the service date
• TRICARE payment note: NOT PUBLISHED
• TRICARE provider recognition note: YES: the provider must submit certification paperwork to become TRICARE-authorized; the claim is denied if the provider was not authorized on the service date

Confirm the address, fax number or portal path on the insurer's own claims page before you send; read on 10-09-2026.