<h2>CLAIM FORMS</h2> <p>Claims for care received overseas must be filed within three years of the date of service or within three years of the date of an inpatient discharge.</p> <p>Claims for care received in the United States or U.S. territories (American Samoa, Guam, the Northern Mariana Islands, Puerto Rico, and the U.S. Virgin Islands) must be filed within one year of the date of service or the date of an inpatient discharge.</p> <p>Send your claims to the {contentlink=/beneficiaries/claims/top-claims-mailing-addresses; fontweight=400:TOP claims processor for the overseas area where you live}. If you receive care while traveling, file your TRICARE claims in the area where you live, not the area where you received care.</p> <p>Claims may also be submitted via the secure beneficiary claims portal using automated direct deposit! Download the {color=#0077CC;downloaddocs=/beneficiaries/tco-media/documents/achdirectdeposit-final:ACH Direct Deposit Registration Guide} to learn more.</p> <p>{nomargin: <a href="https://www.esd.whs.mil/Portals/54/Documents/DD/forms/dd/dd2642.pdf" target="_blank">TRICARE DoD/CHAMPUS Claim Form - Patient's Request for Medical Payment (DD Form 2642)</a>}</p> <p>Beneficiaries filing their own medical claims must use this form to receive reimbursement from the TOP Claims Processor for TRICARE Covered Services.</p> <p>{color=#0077CC;downloaddocs=/beneficiaries/tco-media/documents/TRICAREOHIQuestionnaire01:TRICARE Other Health Insurance Questionnaire}{nomargin: }</p> <p>If you have other health insurance in addition to TRICARE, this questionnaire must be filled out and sent back to the TOP Claims Processor in order to properly declare your other type of insurance.</p> <p>{color=#0077CC;downloaddocs=/beneficiaries/tco-media/documents/Overseas_Estate_Notification:Overseas Estate Notification Form}{nomargin: }</p> <p>This form is used to notify the TOP Claims Processor that your loved one is now deceased. We regretfully request that the following information be provided so we may update our files accurately.</p> <p>{fontweight=500:Note:}<i>&nbsp;TRICARE Overseas beneficiaries must submit proof of payment with all claims. When submitting your DD Form 2642, you should also include an itemized bill or invoice, diagnosis describing why you received medical care, and/or an explanation of benefits from your other health insurance, if applicable.&nbsp;</i><a href="http://www.tricare.mil/proofofpayment" target="_blank">Click here</a><i>&nbsp;for additional information regarding Overseas Proof of Payment.</i></p>