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Tricare dd 2642 Form: What You Should Know

Forms — TRI CARE West Claims — TRI CARE West Patients may have to wait several months before they are contacted by a third party to establish eligibility for payment, which may increase the length of treatment.  Be sure to discuss payment with the third party provider first. The form can be used for all providers except health centers that will be paying for emergency services. Duty to Pay for Medical Care Resulting from an OF/OF Combat-Related Injury and Illness This form is used to establish responsibility for medical care to which you or the beneficiary is entitled because of your post-traumatic stress disorder or traumatic brain injury. It is used by health-policy holders to establish liability for treatment by health care providers who have been directed to treat your condition by a physician under a policy-specific waiver. Form — Duty to Pay for Medication This form is used to establish responsibility for treatment you receive and has to do with medication or other health-related products that you receive from the VA, military, or civilian medical or other program with an indemnity program (in most cases, with the Department of Defense) to the extent they are determined by the Office of Unpaid Care to be medically necessary. It is used to submit claims for reimbursement by the VA or Department of Defense programs if: · You are receiving treatment by a licensed health-care provider covered by a health-policy or health-contingent benefit policy under VA regulation or other authority that would be included in the claim form under the TRI CARE health-care reimbursement program, as a member of TRI CARE Reserve Component, or as a dependent of a member;; The health-benefit policy or health-contingent benefit program requires a referral for the treatment or care to be paid for by VA, and no other facility pays; or · You were receiving treatment by a health-care provider covered by a health-contingent benefit policy under VA regulation or other authority that would be included in the claim form under the TRI CARE health-care reimbursement program, as a member of a TRI CARE Reserve Component, or as a dependent of a member. Your treatment by the particular health-benefit policy is at issue in the claim form.

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