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Factual Appeals

You can file a factual appeal when TRICARE:

  • Denies payment for services or supplies received
  • Terminates payment for services or supplies that were previously authorized

When filing an appeal, keep copies of everything.

Filing Your Appeal

  • Send a letter to the contractor's address specified in the notice of the right to appeal listed on your explanation of benefits (EOB) or other decision
  • It must postmarked or received within 90 days of the date on the EOB or other decision 
  • Include a copy of the EOB or other decision along with any documents
  • If you can't get all the supporting documents in time, send the appeal and state that you'll be sending additional information soon

If the amount you're appealing is less than $50, the contractor's decision is final. If the amount is more than $50 and the letter identifies the Defense Health Agency as the next level of appeal, you can request a formal review.

Requesting a Formal Review

  • Send a letter to the Defense Health Agency 
  • It must be postmarked or received within 60 days of the date on the initial determination or reconsideration decision 
  • Include copies of the decision along with additional supporting documents
  • The Defense Health Agency will issue a formal review decision 

If the disputed amount is less than $300, the Defense Health Agency's decision is final. If the disputed amount is more than $300, you can request an independent hearing.

Requesting an Independent Hearing

  • Send a hearing request to the Defense Health Agency
  • It must be postmarked or recieved within 60 days of the date of the appeal decision 
  • Include a copy of the formal review decision being appealed and any supporting documents not previously submitted

An independent hearing officer will conduct the hearing at a location convenient to both the requesting party and the government. The hearing officer will issue a recommended decision and the Defense Health Agency director (or designee) or the Assistant Secretary of Defense for Health Affairs will issue the final decision.

Last Updated 7/14/2014

contact Your Contacts
Send appeals and appeals correspondence to:

Defense Health Agency
Appeals, Hearings and Claims Collection Division
16401 E. Centretech Parkway
Aurora, CO 80011-9066

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