Claim Dashboard
Track submissions, status and reimbursements
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Total
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Processing
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Paid
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Denied
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Claimed EUR
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Claimed USD
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Reimbursed USD
No claims recorded yet
Add your first claim record after you submit a package to TRICARE.
How this works: Fill in Sections 1–3 once. Use the four buttons at the bottom to generate each document. Sign your DD 2642, then use the Claim Package button to bundle everything for submission. Your data is never uploaded or stored.
Section 1
TRICARE Claim Form (DD Form 2642)
Patient information
Patient contact
Goes in the first phone block: ( )
Sponsor information
🔒 Your SSN is written directly into your PDF on this device and is never transmitted or stored. Privacy Statement
Field 7 — Patient's condition
Field 8c — Additional claim info
Section 2
TRICARE Billing Information
Required for all non-pharmacy claims. Incomplete or missing billing information is one of the most common reasons TRICARE claims are delayed or rejected. This information must match your provider's billing statement exactly — facility name, address, and treating provider. For pharmacy claims, your pharmacy receipt serves as the billing document.
Section 3
TRICARE Claim Portal Information
Add one or more line items for a single visit, treatment day, or pharmacy pickup. Billed and paid amounts are totalled automatically.
Total billed
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Total patient paid
0.00
Section 4
TRICARE Claim Package
The Claim Package bundles your signed DD 2642, Billing Information, itemized bills, and proof of payment into one submission-ready PDF in the correct order.
Complete Steps 1–3 and sign your DD 2642 before generating the package.
Complete Steps 1–3 and sign your DD 2642 before generating the package.