1.  Applies to both Inpatient and Outpatient treatment.

2.  Submitted documents must be English to avoid processing delays.

3.  Notice:  TRICARE does not reimburse these frequently claimed items:
            —  Private Room (unless ordered by a doctor).  Itemized Bill must say Semi-Private.  (Patient pays the full cost difference between Semi Private and Private.)
            —  Private Nurse or Attendant.
—  Personal Items or Telephone Expenses.
—  Translation Service.
—  Translation.  (TRICARE only reimburses for urgent/emergent Ambulance.)

4.  Wisconsin Physicians Service (WPS):  http://www.tricare4u.com/ 

5.  Helpful Hints for these on reverse:

*DD Form 2642- TRICARE Medical Claim.  (Submit Original Signature)

*Medical Certificate, OPD Report or Medical Report (See#3 reverse)

*Intemized Bills.

*DD Form 2527-Possible Third Party Liability.  (If applicable; see#5 reverse)

*Medical Care Summary Worksheet.  (Optional; see#6 reverse)

*Keep a Copy!  (Send Original-2642, but can submit copies of other documents

Mail Claims To:
WPS-Foreign Claims
P.O. Box 7985
Madison, WI 53707-7985