Timely filing · military health plan
TRICARE timely filing limit
Short answer
The TRICARE timely filing limit is one year from the date of service, or one year from the date of discharge for inpatient care, for care received in the United States and its territories; claims for care overseas get three years.
The regulation behind it, 32 CFR 199.7(d), says a claim filed after the deadline waives all rights to benefits for those services unless the requirement is waived, and it lists the circumstances in which the Defense Health Agency may grant an exception. An appeal of a denied claim has to reach the regional contractor within 90 days of the date on the explanation of benefits. Compare other payers in the timely filing limits table.
Last reviewed by the Remitwright billing team. Editorial policy
The windows
- Initial claim
- One year from the date of service, or one year from the date of discharge for inpatient care (three years for care received overseas)1
- Counted from
- The date of service, or the date of discharge for inpatient care, to the date the TRICARE contractor receives the claim.
- Appeal
- 90 days from the date on the explanation of benefits or other decision to file an appeal with the regional contractor
- Corrected claim
- A claim returned for additional information must be resubmitted by the later of one year after the service or 90 days from the date it was returned.
- Verified
- , against the payer document in the sources
Your participation agreement can set a different window. Where the contract and the manual disagree, the contract applies.
A visit on Monday, March 2, 2026
Counting one year forward from a date of service of Monday, March 2, 2026 gives Tuesday, March 2, 2027. That is the last day to file under the first limit shown above; a claim filed after it is outside the window unless one of the exceptions below applies.
Exceptions the payer allows
Retroactive eligibility
A retroactive TRICARE eligibility determination is the first type of exception in 32 CFR 199.7(d)(2). Request it from the contractor with the eligibility notice and the claim that was denied as late.
Administrative error
Misrepresentation, mistake or other accountable action of an officer or employee of the Defense Health Agency or a TRICARE contractor, acting within the scope of their authority, that caused the late filing.
Mental incompetency
Mental incompetency of the beneficiary, or of the guardian or sponsor in the case of a minor child, including an inability to communicate even when it results from a physical disability.
Delays by other health insurance
Delays in adjudication by another health insurer when double coverage coordination is required before TRICARE can determine benefits, as long as the delay is not attributable to the beneficiary.
Other waiver authority
The Director may waive the filing deadline in other circumstances when the waiver is needed to ensure adequate access to health care for beneficiaries.
What counts as proof of timely filing
- The clearinghouse acceptance report for the original submission showing the regional contractor received and accepted the claim, with the patient, date of service and submission date
- The 277CA acknowledgement for the original claim
- For a claim returned for more information, the contractor's return notice with its date, which starts the 90-day resubmission window
- For other-insurance delays, the other carrier's EOB showing when it adjudicated
Notes for billers
- Requests for an exception go to the contractor for the region where the service was rendered and must include a complete explanation of the late filing, all available supporting documentation and the specific claim that was denied; each request is reviewed on its own merits (32 CFR 199.7(d)(2)(ii)).
- Claims and appeals go to the regional contractor named on tricare.mil: Humana Military for the East Region, TriWest Healthcare Alliance for the West Region, International SOS overseas and WPS for TRICARE For Life.
- After the contractor's appeal decision, a formal review by the Defense Health Agency must be postmarked within 60 days of that decision, and a hearing request within 60 days of the formal review decision. Dollar thresholds apply to both.
- Neither tricare.mil nor the regulation lists specific documents accepted as proof of timely filing; the proofs above are the ones payers generally accept.
FAQ
Questions about TRICARE deadlines
What is the TRICARE timely filing limit?
How long do I have to appeal a TRICARE claim denial?
Does TRICARE grant exceptions to the one-year deadline?
The contractor returned my claim for more information. What is my deadline?
Which contractor gets my claim and my appeal?
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