Contact your unit representative and the nearest same-service Military Treatment Facility and ask for the Patient Administrator or the Benefit Counseling and Assistance Coordinator. Each should be able to assist.

In Puerto Rico, all information for eligibility and Line of Duty Determination is processed by Rodriguez Army Health Clinic at Fort Buchanan. Please forward all necessary documentation there.

Eligibility is determined by drill attendance rosters and orders. After it ends, you are no longer eligible for care. All care should take place while you are still in duty status. Any claims after eligibility dates must have a Line of Duty Determination and pre-authorization.

The TRICARE Overseas Program contractor should process claims for the Continental United States. If you received civilian health care while on orders, traveling, or visiting abroad regardless of where you reside or where you are enrolled, the TRICARE Overseas Program contractor should process the claims. (See TRICARE Operations Manual and refer to Chapter 8, Section 2, paragraph 3.0.)

You will first need to register for a beneficiary account via the contractor’s portal. You can then view claims, authorizations, and Explanation of Benefits. 

• East region: https://infocenter.humana-military.com/beneficiary/service/Registration/Registration 
• West region: https://www.tricare-west.com/content/hnfs/home/tw/bene/res/beneficiary-education-materials.html  

Defense Health Agency, Great Lakes does not pay claims. When your eligibility is verified, we authorize payment of claims by TRICARE.

When you retire/separate, you lose your Line of Duty eligibility. This also makes your pre-authorization(s) invalid. If you are still receiving care AFTER separation/retirement date, it will be denied. However, you may go to Veterans Affairs for continual care, if you are deemed eligible.

Your unit can contact us via phone at 888-647-6676, option 2, then opt 3. You may also email us at: dha.great-lakes.j-10.mbx.mmso-lod-misc@health.mil. Before contacting us, please ensure you have the billed amount and date of service. Please do not send us bills. 

TRICARE uses your Social Security number to verify your eligibility. You may also provide your Department of Defense Benefits Number/DOD Identification Number.

The provider should bill the region of your Home of Record in the Defense Enrollment Eligibility Reporting System. Your Home of Record should reflect where you currently reside.

All TRICARE Prime Remote concerns/issues must go through your regional contractor.

Defense Health Agency, Great Lakes does not address dependent claims. All dependent concerns must go through your regional contractor.

There could be several reasons. You can review your Explanation of Benefit or give us a call at 1-888-647-6676 for review.

If our office cannot see or enter your eligibility on file, we cannot authorize claim payments.

Defense Health Agency does not process claims for Coast Guard. You must contact the Coast Guard Service Point of Contact at 757-628-4379.

The claim(s) have not been submitted to TRICARE by your provider/hospital. If they need further assistance have them contact your correct regional contractor.

The Defense Enrollment Eligibility and Reporting System does not reflect LOD so claims will default to TRS instead of your LOD and/or pre-authorization. If there is a cost-share/copayment associated with that claim, have your unit contact us so we can direct TRICARE to remove the copayments.

Defense Health Agency, Great Lakes does not handle dental claims. All dental claims and Line of Duty information must be routed through United Concordia, at:

United Concordia ADDP Authorization
P.O. Box 69431
Harrisburg, PA 17106-9431

TRICARE has 30 business days (excluding weekends and holidays). You can track the status on your region’s beneficiary website.

Pull a copy of your Explanation of Benefits and contact provider’s billing office about it. If that does not resolve the issue, contact your TRICARE regional contractor and request balance billing letter(s) be sent to the provider.

Defense Health Agency, Great Lakes is not involved in recoupments. Please contact your TRICARE regional contractor. You can also contact the TRICARE Health Plan Customer Service Line at 844-204-9351, option 6, for assistance.

Please note that  Defense Health Agency, Great Lakes/Military Medical Support Office has no authority to contact private sector providers and direct them to file TRICARE Line of Duty Claims. Contact your regional contractor and request to speak with claims. They should assist on getting providers to bill.

Sometimes providers are uncomfortable submitting electronically if the Defense Enrollment Eligibility and Reporting System says you are ineligible for care. If they are unable to submit electronically, then they need send claims to TRICARE via fax or mail using a CMS 1500 form or a UB04 form. These are official insurance claim forms that must be completed by the provider’s office ONLY. 

The provider can manually enter the member’s information: name, sponsor ID/SSN, address, and phone number.

For more information the provider can contact TRICARE directly.

East Region: https://www.humanamilitary.com/provider/

West Region: https://www.tricare-west.com/content/hnfs/home/tw/prov.html 

Defense Health Agency, Great Lakes does not reimburse. You must have the provider bill TRICARE and once providers receive payment from TRICARE, it is up to the provider’s office to refund you anything out-of-pocket. 

Additionally, you can submit a claim for reimbursement to TRICARE by going to https://www.tricare.mil/FormsClaims/Claims for more information.

You must have your provider bill TRICARE. Once your provider receives payment from TRICARE, it is up to the provider’s office to refund your private insurance for any payments made on your behalf.

If you have a Line of Duty, the provider must bill under your own SSN/DBN/DoDID. Line of Duty claims cannot be reprocessed under the incorrect SSN. Authorization is only valid for the Line of Duty condition and if doesn’t match it will be denied.

Defense Health Agency, Great lakes cannot process Periodic Health Assessments as eligibility/Line of Duty care. Learn more: https://www.health.mil/Military-Health-Topics/Health-Readiness/Reserve-Health-Readiness-Program. 

First, register for your regional contractor’s beneficiary portal to check if the claim(s) have been submitted to TRICARE. If the claim is in the portal, your unit can contact us to authorize TRICARE to reprocess the claim(s). If the providers have not billed TRICARE, you should provide them TRICARE’s billing information. If further issues persist, you can fill out a debt collection package located on our main website and in our process guide.

Have your unit representative submit the DHA-GL Worksheet-1, the certified orders/roster, and the Emergency Room/Urgent Care provider’s notes. These documents will validate that you were eligible to receive medical care at government expense. If eligible, TRICARE contractors will pay the provider for care with zero cost-shares or copayments.

No, your eligibility validation package must come from your unit representatives.

If you are U.S. Navy Reserve, U.S. Marine Corps Reserve, U.S. Air Force Reserve, or Air National Guard, your unit representative can send required documents to our specified organization email box: dha.great-lakes.j-10.mbx.mmso-lod-misc@health.mil. (Do not send bills)

**Army: If you are Army National Guard/U.S. Army Reserve, your unit representative must use eMMPs via MEDCHART to submit your eligibility.

Note: This box can only accept emails from .mil addresses.

This is not a Defense Health Agency, Great Lakes mandate. All Army National Guard/U.S. Army Reserve requests are required by the National Guard Bureau and Office of the Chief of Army Reserve to be submitted via the Electronic Medical Processing System (eMMPS/MEDCHART). Defense Health Agency, Great Lakes will not accept Army Reserve Component eligibility packages submitted by mail, fax, or email.

** If you are a Unit Administrator seeking more information about MEDCHART access or instructions, please contact your chain of command.

Your unit representative does not need to submit your eligibility. Your Defense Enrollment Eligibility Reporting System record should reflect your time as active duty which will prompt TRICARE to pay your claims as TRICARE Prime Remote. If you need follow-up care after your orders end, your unit representative should submit a pre-authorization request along with the required documentation.

The requirement for CAC verified signatures validates and confirms the identity of the unit representative who submitted the document.

Defense Health Agency, Great lakes reviews each case. If the eligibility documents submitted by your unit representative did not meet incurred criteria or aggravated criteria, the government is not obligated for the payment. Some examples are:

• Existed prior to (drill) service
• Gross negligence
• Misconduct
• Drug use
• Sexually transmitted infections
• Annual health assessments
• Behavioral health
• Alcohol misuse/withdrawal
• Medication refills
• MRI

"Eligibility on file" means we have verified and approved your eligibility documents. The claims sent to TRICARE that are associated with your line of duty injury or illness will be authorized for payment.

DHA-GL phone hours are 0830-1100 and 1300-1530 CST, Monday thru Friday, excluding holidays.

If you live within 50 miles of a military hospital or clinic, Defense Health Agency, Great Lakes can only assist with emergent/urgent care ONLY while you are on orders under 30 days. Any care after the orders ends falls under the jurisdiction of the military hospital or clinic.

Military hospitals and clinics are mandated by law to assist and render care to members within catchment of their facility. Ensure you give your approved Line of Duty to the Patient Administrator within the facility. Please refer to HA POLICY: 11-005 for more information.

Speak with Patient Administrator/Referral Management at the military hospital or clinic. They should refer you out to a civilian provider.

Contact the Beneficiary Counseling and Assistance Coordinator for assistance. To find the closest Beneficiary Counseling and Assistance Coordinator to you, click on link https://tricare.mil/bcacdcao. If the Beneficiary Counseling and Assistance Coordinator is not on the site, call the military hospital or clinic directly for the information.

• If you reside in the TRICARE East Region, register for the Humana Military beneficiary self-service portal at: https://infocenter.humana-military.com/beneficiary/service/Registration/Registration
• If you reside in the TRICARE West Region, go to the Health Net portal at: https://www.tricare-west.com/content/hnfs/home/tw/bene/res/beneficiary-education-materials.html 

If you have questions or need more information about these portals, please contact your regional contractor. 

Unit representatives may also sign up for access to the government portal at the web address above. Claims can only be paid if you have eligibility/Line of Duty on file AND claims have been sent to the regional contractor.

Tips

• Register to track claims and authorizations.
• East: https://www.humanamilitary.com/provider/
• West: https://www.tricare-west.com/content/hnfs/home/tw/prov.html
Make sure your unit has submitted your eligibility/LOD paperwork.
• Save your Explanation of Benefits, it is a receipt as proof of payment.
• Make sure your Defense Enrollment Eligibility Reporting System record is up-to-date.

** RETAIL PHARMACY ONLY** Please view our process guide for reimbursement instructions. Our office does NOT reimburse. Defense Health Agency, Great Lakes will confirm your eligibility is on file and then we will forward your documentation to the TRICARE pharmacy contractor and they will send you a check in the mail.

No. Once you separate/retire, all pre-authorizations become invalid.

If you are U.S. Navy Reserve, U.S. Marine Corps Reserve, U.S. Air Force Reserve, or Air National Guard, your unit representative can send required documents to our specified organization email box: dha.great-lakes.j-10.mbx.mmso-initial-lod-mma@health.mil. (Do not send bills)

**Army: If you are Army National Guard/U.S. Army Reserve, your unit representative must use eMMPs via MEDCHART to submit your pre-authorization request

Note: This box can only accept emails from .mil addresses.

To check the status of your authorization, you must be registered with a beneficiary account on your region’s website.

Your unit representative needs to submit the DHA-GL Worksheet-02, and clinical notes validating that the medical condition was incurred or aggravated while you were in a qualified duty status, and an approved Line of Duty Determination.

The Line of Duty Determination from your initial claim will be used to authorize appropriate medical treatment for your covered condition for no longer than one year from its diagnosis. If your condition persists longer than one year, and criteria are met, you may be identified for referral to the Disability Evaluation System.

To ensure you are eligible so your medical claims will be paid.

No. Your unit representative can submit another Line of Duty Determination with the updated injury and diagnosis for review. 

Pre-authorization is determined on a case-by-case basis, but typically should not exceed 365 days from the time of injury. Always be sure to check the expiration date of your authorization.