TRICARE West (TriWest)

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

Read date: 10-09-2026

Research steps

1. Portal upload is NO for a domestic Texas medical claim. TRICARE publishes online claim filing only for overseas claims. https://www.tricare.mil/PatientResources/Claims/MedicalClaims
2. Complete all 12 blocks of DD Form 2642, Patient's Request for Medical Payment, and sign it. https://www.tricare.mil/PatientResources/Claims/MedicalClaims
3. Attach a readable provider bill with the sponsor DoD ID or DBN, provider name and address, date and place of each service, description, charge for each service, and diagnosis. https://www.tricare.mil/PatientResources/Claims/MedicalClaims
4. Add the other insurer's EOB when other health insurance pays first. Add the injury form when the condition is accident or work related. https://www.tricare.mil/PatientResources/Claims/MedicalClaims
5. The member signature must be a physical wet signature or Common Access Card signature. A typed signature is not published as accepted. https://www.esd.whs.mil/Portals/54/Documents/DD/forms/dd/dd2642.pdf
6. No domestic upload step exists. The published domestic route is nonportal, so an upload-only recoupr package cannot be filed through the West portal. https://www.tricare.mil/PatientResources/Claims/MedicalClaims
7. Check claim status and EOBs in the TRICARE West Region Beneficiary Portal. https://www.tricare.mil/PatientResources/Claims/MedicalClaims

Filing facts

• Portal upload: NO
• Portal: TRICARE West Region Beneficiary Portal, status only
• Portal path: Domestic West claims have no upload path; the official medical-claims page publishes nonportal submission and reserves online filing for overseas claims
• Mail address: TRICARE West Region Claims, P.O. Box 202160, Florence, SC 29502-2160
• Fax: 877-989-0070
• Attach: sponsor DoD ID or DBN; provider name and address; date and place of each service; description of each service or supply; charge for each service; diagnosis; other-insurance EOB when applicable; proof of payment for overseas claims
• File types: NOT APPLICABLE
• File size limit: NOT APPLICABLE
• Maximum files: NOT APPLICABLE
• One file or separate files: NOT APPLICABLE
• Confirmation: NOT APPLICABLE
• Status check: TRICARE West Region Beneficiary Portal shows claim status and EOBs
• Processing time: NOT PUBLISHED
• Member deadline: United States and US territories: one year from service, or one year from inpatient discharge; overseas: three years from service; returned claims: original limit or 90 days from notice, whichever is later
• Deadline basis: YES: domestic, inpatient, overseas, and returned-claim rules differ
• Mental health route: Use DD 2642 and the domestic West claim route; no separate mental-health claim submission route is published
• 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: Member or beneficiary reimbursement after paying a nonparticipating provider; DD 2642 has no assignment-of-benefits field
• 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.