Tricare Dod/champus Medical Claim Patient's Request 2020-2024

Tricare Dod/champus Medical Claim Patient's Request: What You Should Know

Note: You must include your name, date of birth, social security number, and the date your claim is made; you also must include your medical condition and address you use for medical services; you also must provide information about when you are seeking to be compensated; and YOU MUST SEND ALL OF YOUR CLAIMS TO THE PHYSICIAN YOU HAVE BEEN TREATED BY PRIOR TO CLAIMING. This form must be submitted no later than Dec 13, 2021. The form must meet the minimum requirements described below as soon as practicable after its receipt by TRI CARE. Note that it is best if you have someone who understands the basics of making and filing claims electronically, to review the claim form for you. Claims must meet the following minimums before TRI CARE will send payments to a health care system or other third-party payer. Each claim must be made by either an injured or ill individual, or their designated representative; or, any individual who is responsible for an individual patient's medical care who is incapable of taking care of himself/herself; or, a member of the employee's household, spouse, dependent child under the age of 21, or other legal ward who meets the eligibility criteria set forth in Section 1.10.1 of the TRI CARE Act.  • The injured person must be a United States citizen or permanent resident (including a U.S. national who is a dependent of the alien); • Any health care provider in receipt of a claim must be at least 18 years old and must have successfully completed a training course for health care providers or practitioners in the United States or a foreign country, unless the provider is an individual in the Armed Forces of the United States; and • The authorized representative must be a citizen of the United States, or the eligible patient's spouse, or a resident of the United States (including a U.S. national who is a dependent of the alien), or other authorized representative of an alien. (It is also required, however, that if the injured individual, or a related family member, is unable to take care of himself or herself due to a service-connected disability, the alien may be the guardian at law or in equity or in the United States for the alien's minor children.

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