We are certified out-of-network (OON) with TRICARE
Navigating the out-of-network status for providers in the Hampton Roads area can be frustrating. We are here to help make the process easier to understand so there will be minimal disruptions to your care.
How to Submit a Superbill to Tricare for Reimbursement
Simply put, when you see an out of network provider, you:
Pay your provider the full session cost for services at the time of the appointment.
Receive a superbill for session either after every session or once a month, depending on the practice’s policy.
Submit your superbill to tricare and get reimbursed directly from them.
Active duty
Have your PCM or SMO put in a referral with the specific name of the provider and the name of the practice (i.e. Kayla Gasper, LPC at Coastal Art Therapy Services).
On the referral you PCM or SMO will need to write the medical necessity for mental health services. Also on the referral submission, the PCM or SMO will need to write a justification of why a certified out of network provider is necessary and how they can provide the necessary services that base programs or in network providers.
Examples:
Provider specializes in CPT which is evidence-based for PTSD while the majority of other practices in the area provide EMDR.
Provider specializes in RO DBT which is evidence-based for refractory/chronic depression while other practices in the area provide general CBT for depression.
This referral will need to be faxed to 757-432-3306
A referral will need to be received in order for you to be able to submit a super bill for reimbursement. Otherwise your claim will be processed using your Point of Service (POS) option, meaning you will have a small deductible and a shared cost for services (which could vary between $45-$55).
Dependent (Spouse or child of service member)
Dependent who has Tricare Prime: Typically, Tricare requires you to have a referral to receive services for a provider who is Certified Out of Network. Your PCM can submit this referral
Have your PCM put in a referral with the specific name of the provider and the name of the practice (i.e. Kayla Gasper, LPC at Coastal Art Therapy Services). The referral will need to be faxed to 757-432-3306
On the referral you PCM or SMO will need to write the medical necessity for mental health services. Also on the referral submission, the PCM or SMO will need to write a justification of why a certified out of network provider is necessary and how they can provide the necessary services that base programs or in network providers.
A referral will need to be received in order for you to be able to submit a super bill for reimbursement. Otherwise your claim will be processed using your Point of Service (POS) option, meaning you will have a small deductible and a shared cost for services (which may vary between $45-$55).
Dependents who are Tricare Select, Tricare Reserve Select, Tricare Retired Reserve, and Tricare Young Adult-Select you don’t need a referral.
How to submit Superbill after completed services
You will receive a superbill that will include: The provider’s name, address, NPI number, procedure code (CPT), date of service, amount charged, and proof of payment or receipt. (All will be found in your patient portal)
You will then need to fill out DD Form 2642 – Patient’s Request for Medical Payment. This is the official claim form used when patients submit their own claims. You will include sponsor information, patient details, provider information, service details, and the amount paid.
View the form here: https://www.esd.whs.mil/Portals/54/Documents/DD/forms/dd/dd2642.pdf
Attach required documents: Include the completed DD Form 2642, the superbill from the provider, and proof of payment such as a receipt or credit card statement.
Submit the claim to your TRICARE contractor: Claims are submitted to your TRICARE regional contractor. This can usually be done by mail, fax, or through the beneficiary portal depending on your region.
View the form here: https://tricare.mil/PatientResources/Claims/MedicalClaims