Categories: Armed Forces News

Exceptions to 1-year Tricare Claims Limit

Exceptions to the one-year claims filing deadline (previous item) apply if one or more of the following situations occur:

The beneficiary was Tricare-eligible at the time of service, but the Defense Enrollment and Eligibility Reporting System did not reflect the eligibility until after the filing limit;

Retroactive preauthorization was received after the filing limit expired;

Tricare Management Activity or the regional contractor made an administrative error;

A legal guardian responsible for managing the affairs of a mentally incompetent patient or a patient unable to communicate was appointed after the filing date was reached;

The provider submitted the claim as a Tricare-participating provider after changing from a non-participating provider;

The patient submitted a claim to their other health insurance underwriter in a timely fashion and the insurance plan was responsible for a delay beyond the one-year filing date; or

Medicare accepts Tricare for Life claims as timely.

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