OCONUS Areas outside of the 50 United States, the District of Columbia, American Samoa, Guam, the Northern Mariana Islands, Puerto Rico, and the U.S. To file a pharmacy claim, complete the TRICARE DOD/CHAMPUS Claim Form-Patients Request for Medical Payment (DD Form 2642) Opens the TRICARE Claim Form.
Box 7968 Madison, WI 53707-7968 Eurasia Africa (All Others) TRICARE Overseas Program P.O.
Because processors manage claims separately, if you send multiple claims in together, a problem with one claim. Send your claim form and supporting documentation to: CONUS 50 United States, the District of Columbia, American Samoa, Guam, the Northern Mariana Islands, Puerto Rico, and the U.S. Box 202112 Florence, SC 29502-2112 Overseas (Active Duty) TRICARE Active Duty Claims P.O. claims separately do not bundle multiple claims. But, if you're authorized to visit a non-network dentist, you may have to submit your own claims. For your convenience, this form can be filled out online, printed and mailed to United Concordia.
Your regional contractor will send you the Statement of Personal Injury-Possible Third Party Liability (DD Form 2527) You must complete and sign this form within 35 calendar days. United Concordia's network dentists will file claims for you. NARF (Non Availability Referral - OCONUS Only) A NARF is an OCONUS form used by Overseas Dental Treatment Facilities (ODTFs) and TRICARE Area Offices (TAOs) to refer enrolled members to local host country dentists for orthodontic services. The Federal Medical Recovery Act allows TRICARE to be reimbursed for its costs of treating you if you are injured in an accident that was caused by someone else.
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