The deadline does not change by region. TRICARE East and TRICARE West both run on the same one-year window, because it is a programme rule rather than a contractor rule. What the region decides is where the claim goes — and a claim sent to the wrong contractor can burn most of that year before anyone notices.
| Situation | Filing deadline | Where it goes |
|---|---|---|
| TRICARE East | 1 year from the date of service — date of discharge for inpatient | Humana Military |
| TRICARE West | 1 year from the date of service — date of discharge for inpatient | TriWest Healthcare Alliance, from 1 January 2025 |
| TRICARE For Life | Same one-year window, but Medicare adjudicates first | Medicare first; the claim normally crosses over automatically |
| Corrected claim | Still inside the original one-year window — the contractor’s own resubmission window runs separately | Same contractor, carrying the original claim control number |
Two practical consequences. First, searching for a separate “TRICARE West timely filing limit” is looking for a number that does not exist — it is the same year, and the useful question is whether TriWest or Humana Military should have received the claim. Second, on TRICARE For Life the clock that usually kills the claim is Medicare’s, not TRICARE’s: if Medicare denies or the crossover fails, the TFL claim sits unfiled while the year runs down.
Put your own date of service in the timely filing calculator to get the exact deadline and the days you have left, and switch it to appeal mode to work a reconsideration deadline from the EOB date. TRICARE programme rules and contractor assignments are set federally and change periodically — confirm anything claim-specific with your regional contractor.
| Timely filing | 1 year from date of service — or date of discharge for inpatient |
| Who you bill | The regional contractor, not TRICARE directly |
| East region | Humana Military |
| West region | TriWest Healthcare Alliance (from 1 Jan 2025; previously Health Net Federal Services) |
| Order of payment | Last payer after other health insurance — but pays before Medicaid |
| Provider status | Must be TRICARE-authorized to be paid at all; network status is separate |
The most common structural mistake with TRICARE is treating it as a single insurer. It is a federal health programme administered by regional contractors, and the contractor is who you actually bill, enrol with and appeal to.
There are two regions. TRICARE East is administered by Humana Military. TRICARE West changed contractor on 1 January 2025 to TriWest Healthcare Alliance, having previously been Health Net Federal Services — if your payer records or clearinghouse setup predate that, claims may still be routing to the old contractor and simply going nowhere.
A claim sent to the wrong region does not usually deny in a way that lands in your work queue. It produces no response at all, which is far worse: the claim sits, nobody chases it because there is no remittance to work, and the filing clock runs. If you have TRICARE claims with no adjudication and no rejection, check the region before anything else.
| Plan | Works like | What it means for your claim |
|---|---|---|
| TRICARE Prime | Managed care / HMO | Assigned primary care manager; most specialty care needs a referral on file |
| TRICARE Select | PPO | Self-managed, no referral for most covered care, higher cost shares |
| TRICARE For Life | Medicare wraparound | Medicare pays first, TFL second — usually automatic crossover |
The Prime referral requirement is where most avoidable denials come from. A Prime beneficiary seeing a specialist without a referral from their primary care manager is not covered for that visit, and the denial is correct. Verify the referral is on file before the appointment, not after the denial — retroactive referrals are difficult and often refused.
TRICARE is a payer of last resort among health coverage, with one important exception. If the beneficiary has any other health insurance — an employer plan, a spouse’s plan, an individual policy — that coverage is billed first and TRICARE pays second. Submitting to TRICARE first when other coverage exists produces a denial for other health insurance on file.
The exception is Medicaid: TRICARE pays before Medicaid, because Medicaid is the payer of last resort in every context. And for TRICARE For Life beneficiaries, Medicare is primary and TFL is the secondary, normally crossing over automatically once Medicare adjudicates.
If a TFL claim has not crossed over within a reasonable window, do not simply resubmit — confirm the beneficiary’s coordination records first. Our guide on billing secondary insurance claims covers what the secondary claim needs to carry, and the primary payer decision tool works out who pays first when several coverages are in play.
This distinction has no direct commercial equivalent and it catches new TRICARE billers out.
A provider must be TRICARE-authorized to be paid at all. That is a certification that the provider type, licensure and credentials meet programme requirements. Being authorized is not the same as being in network, which is a contract with the regional contractor sitting on top of authorization.
Authorized non-network providers can be paid, but they are subject to a cap on what they may charge the beneficiary — commonly cited as 115 percent of the TRICARE allowable — and may not balance bill above it. That cap is a programme rule rather than a contractual term, so exceeding it is a compliance issue, not a billing dispute.
TRICARE’s one year from date of service filing window is generous compared with the 90 to 180 days common among commercial payers, which is precisely why TRICARE claims are the ones that quietly age. A year feels like plenty until a claim sits misrouted to the wrong region for eight months.
Work the deadline with the timely filing calculator, and for corrections see the claim frequency code tool — corrected claims still need the original claim control number, and the corrected-claim window is not the same as the original filing window. Compare against other payers in the timely filing limits guide.
One caution: TRICARE programme rules, contractor assignments and cost shares are set federally and updated periodically. Treat the figures here as orientation and confirm current requirements with your regional contractor before relying on them for a specific claim.
Regional routing, referral tracking and TRICARE For Life crossover — we work military health claims for practices across the United States.
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