West Region Instructions

If you have a civilian PCM, the following documents must be submitted via mail, fax, or secured e-mail to the TRICARE Regional Office (TRO)-West Prime Travel Benefit Office. To protect personal information, we strongly discourage transmission of documents via e-mail.

Form/Document Instructions
Prime Travel Reimbursement Request Form

Submit this form with all other supporting documents to get reimbursed under the Prime Travel Benefit.

Electronic Funds Transfer Authorization Form

Submit this form to establish the automatic transfer to recieve the reimbursement electronically. You will only need to submit this form once unless there is a change.

PCM Referral or UnitedHealthcare Referral Authorization Letter

A PCM referral for a medically necessary, non-emergency specialty care is required and the care must be authorized by UnitedHealthcare. If the appointment is at a military hospital or clinic, a copy of the PCM's referral letter and the patient's Composite Health Care System Appointment Schedule is required in place of the UnitedHealthcare authorization letter. Contact UnitedHealthcare 1-877-988-WEST (1-877-988-9378) or www.uhcmilitarywest.com.

Note: If you received specialty care under the authorization waiver (April 1-July 2, 2013) you must submit a copy of the written PCM referral and the waiver letter to qualify for travel reimbursement.

Non-Medical Attendant (NMA) Letter

If applicable, a letter from your PCM recommending that a NMA is appropriate and medically-necessary. Without this recommendation, the NMA will not be eligible for travel expense reimbursement. Federal regulations authorize only one NMA. The NMA must be a parent, guardian, or an adult member of the patient's family who is at least 21 years of age. This requirement is waived when the patient is a minor, less than 18 years of age.

Confirmation of Specialty Care

For verification and audit purposes, complete the attached Confirmation of Specialty Care Form when attending appointments.

Active Duty Service Member/Government Employee NMA Memo

This form must be completed by command or appropriate agency official to authorize TDY travel reimbursement for the NMA (if NMA is on active duty or a federal employee).

Travel Vouchers

If you are traveling alone, complete the Travel Voucher or Subvoucher (DD 1351-2) and Statement of Actual Expenses (DD 1351-3) with receipts.

If you are accompanied by a NMA who is a non-active duty or non-government employee, both the patient and NMA submit the Travel Voucher or Subvoucher (DD 1351-2) and Statement of Actual Expenses (DD 1351-3) with receipts.

If the NMA is an active duty service member, only the Travel Voucher or Subvoucher (DD 1351-2) with receipts is required.

Travel reimbursement claims for travel occurring on or after April 26, 2012 must be filed no later than one year after the qualifying travel date.

Receipts

Original or legible receipts are required to support all travel documentation.

Prime Travel Benefit Checklist

This form should be completed and signed to acknowledge that if you submit an incomplete packet, it may result in your reimbursement being delayed or not processed. All documents on the checklist must completed and included in the packet submission for reimbursement. 

Submit Packages

Contact the TRO-West Travel Benefit Office via phone or e-mail:

Submit your complete packet to the TRO-West office via fax or mail:

TRICARE Regional Office-West
Attn: Prime Travel
401 West A Street, Suite 2100
San Diego, CA 92101

Fax: 1-619-231-4245

Your Reimbursement

Submitted travel claims will be processed using the Defense Travel System. Receipts supporting all reasonable travel expenses submitted for reimbursement must be included with each claim. Government rates will be used to estimate the reasonable cost. Beneficiaries are expected to use the least costly mode of transportation. The actual costs of lodging (including taxes) and the actual cost of meals (including taxes and tips, but excluding alcoholic beverages) may be reimbursed up to the government rate for the area concerned. >>View Governement Rates

Last Updated 2/20/2014

contact Your Contacts
West Prime Travel Office

1-800-449-6408

TRO-West
Attn: Prime Travel
401 West A Street, Suite 2100
San Diego, CA 92101

Fax: 1-619-231-4245
Send an Email 

www.tricare.mil/trowest/Prime-Travel.cfm
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