TRICARE Timely Filing Limit 2026: East, West and TFL Deadlines

TRICARE Timely Filing Limit: The One-Year Rule, the Six Exceptions, and What to Do After a CO-29

Category: Medical Billing

Posted By: Andrew Christian

Posted Date: Sep 23, 2026

The TRICARE timely filing limit is one year from the date of service, or one year from the inpatient discharge date for facility charges. Overseas claims get three years.

That part is simple. What costs practices money is everything after it: the second clock running on secondary claims, the corrected-claim rule TRICARE never published, and the CO-29 sitting on a remittance right now that somebody is about to write off.

  • Standard deadline: one year from date of service or inpatient discharge
  • Overseas: three years from date of service
  • Secondary claims: 90 days from the other insurer’s adjudication date
  • Denial code when you miss it: CO-29
  • Active Duty Service Members: timely filing doesn’t apply

What Is the TRICARE Timely Filing Limit in 2026?

TRICARE gives you one year to get a claim in the door. The clock starts on the date of service for outpatient care and on the discharge date for inpatient facility charges. If the patient lives overseas, that window stretches to three years.

TRICARE filing deadlines by claim type and patient location

Claim scenario

Deadline

Clock starts from

Medical, US and US territories

1 year

Date of service

Medical, inpatient facility charges

1 year

Date of discharge

Medical, overseas

3 years

Date of service or discharge

Dental

1 year

Date of service

Pharmacy

1 year

Date of service

Secondary after other insurance

90 days

Other insurer’s adjudication date

Active Duty Service Member

Does not apply

Not applicable

The deadline by claim type and location

Two rows on that table appear almost nowhere else in published guidance on the TRICARE timely filing limit, and both cost practices money.

Dental and pharmacy carry their own one-year windows, separate from the medical claim. A practice billing adjunctive dental under TRICARE tracks that deadline on its own, not as part of the medical AR.

The overseas rule triples your window. Puerto Rico, Guam, the US Virgin Islands, American Samoa, and the Northern Mariana Islands all count as US territories, so they stay on the one-year clock. Everything outside that gets three years, and overseas claims also require proof of payment submitted with the claim.

Source: TRICARE claims deadline FAQ, updated July 2, 2026

Why the deadline is federal, not contractor policy

Billing TRICARE trips people up because they treat the one-year figure as something Humana Military or TriWest decided. Neither company set it.

The deadline sits in federal regulation at 32 CFR 199.7, and it has applied to every service provided on or after January 1, 1993. Before that date the rule looked different: claims were due by December 31 of the year following the year of service, which gave some claims almost two years and others barely twelve months.

That matters operationally. A contractor can’t shorten the window by contract, and a contractor’s published waiver criteria sit underneath the federal exception categories rather than replacing them.

Source: 32 CFR 199.7, Claims submission, review, and payment

When Does the TRICARE Filing Clock Start?

Date of service versus date of discharge

Outpatient claims run from the date of service. Inpatient facility charges run from the discharge date.

A patient admitted March 3 and discharged March 20 gives the facility until March 20 of the following year. Not March 3. That seventeen-day difference has saved more claims than most billers realize.

Professional services billed by a facility follow a different clock

This is where it gets expensive. Professional services billed by the facility don’t run from the discharge date. They run from the date of service.

Picture a 28-day admission. The facility claim stays safe until one year past discharge. The hospitalist who rounded on day one, billing under the facility’s tax ID, is working against a deadline four weeks earlier. Same patient, same chart, two expiration dates.

Most teams never split them. The facility claim goes out clean, the professional charges sit in a hold queue waiting on documentation, and nobody catches the gap until CO-29 lands on the professional side alone.

Two clocks on one admission: Facility charges run from the discharge date. Professional services billed by that same facility run from the date of service.

Source: TRICARE Operations Manual, Chapter 8, Section 3 (Change 152, September 3, 2025)

Received, not postmarked

The TRICARE timely filing limit measures one thing: the day your claim reaches the contractor. TRICARE claims should be received within the filing window, not simply sent within it. Contractors measure the day the claim lands in their system. Your transmission date, your postmark, and your billing software timestamp carry no weight.

On paper claims near the deadline that gap runs days. On anything stuck behind a clearinghouse edit it runs weeks.

The Medicare timely filing limit works the same way, which is why billers who came up on Medicare tend to get this one right and billers who came up on commercial plans tend to get burned by it.

Source: TriWest provider handbook

TRICARE East, West, and For Life: Do the Filing Deadlines Differ?

The deadline is identical. The routing is not.

Every region runs on the same one-year federal deadline. What changes is which contractor receives the claim, which payer ID routes it, which PO box takes paper, and which waiver criteria that contractor actually publishes.

Same deadline, different rulebooks: The one-year limit is federal and identical across TRICARE East, TRICARE West, and TRICARE For Life. The waiver criteria and submission routing are not.

If you work more than one region, one checklist won’t cover you.

TRICARE East: Humana Military and payer ID 99727

Humana Military administers the East Region. The TRICARE East timely filing limit is one year from the date the services were provided.

Payer ID is 99727, and it goes in three places on an X12 837 file: ISA-08, GS-03, and NM1-09 with the 40 qualifier. Paper claims go to TRICARE East Region Claims, PO Box 202146, Florence, SC 29502-2146.

One detail worth flagging: East directs network providers to file electronically within 90 days of care. That’s a network standard, far tighter than the regulatory year, and it doesn’t appear in any general timely filing reference.

Source: Humana Military claims page

TRICARE West: TriWest, PGBA, and payer ID 99726

TriWest Healthcare Alliance administers the West Region, with claims processed by PGBA. The TRICARE West timely filing limit is one year, stated as 365 days, from the date services were provided or from the discharge date for inpatient facility charges.

Payer ID is 99726. Paper claims go to TRICARE West Claims, PO Box 202160, Florence, SC 29502-2160, fax 1-877-989-0070.

TriWest recommends filing within 30 days of service. Treat that as the operational target, not the deadline.

TRICARE For Life: WPS and the Medicare-first rule

Wisconsin Physicians Service processes TRICARE For Life. Medicare files first, every time. Claims go to WPS TRICARE For Life, PO Box 7890, Madison, WI 53707-7890.

Now the part that costs money. The TRICARE For Life timely filing limit is still one year from the date of service. Medicare accepting your claim as timely is an exception pathway you have to request, not an automatic clock reset.

A biller who waits for a Medicare EOB that issues at month eleven, then files TRICARE on day 300 of a fresh count, has already missed the deadline by roughly nine months.

Source: WPS TRICARE For Life reimbursement

TRICARE Secondary Claims and the 90-Day OHI Rule

Two clocks run at the same time

When a TRICARE patient carries other health insurance, you’re tracking two deadlines at once. Miss either and the claim dies.

The second clock nobody tracks: The one-year window from date of service keeps running. On top of it, the claim has to reach TRICARE within 90 calendar days of the other insurer’s adjudication date.

Run the math on a real one. Commercial primary adjudicates on day 340. You don’t have 90 days. You have 25, because the one-year window closes first and the OHI rule doesn’t extend it on its own.

When the primary blows past the year, that 90-day window becomes the basis for a waiver request instead of a filing right, because the TRICARE timely filing limit has already closed.

Source: TRICARE West waiver criteria

What the EOB has to show before TRICARE will pay

TRICARE needs four things off the primary EOB: beneficiary liability, the original billed amount, the allowed amount, and any discounts applied. An EOB missing the liability breakdown gets the claim denied even when you filed on time.

Send a claim flagged with primary OHI and no EOB or COB payment data attached, and it denies. Send it before the primary has finished processing, and it also denies. Filing early is its own failure mode on TRICARE.

Most of these start at the front desk. The patient doesn’t mention the employer plan, nobody asks, and the OHI surfaces three months later on a denial. Benefit verification before the visit catches it while the claim is still fixable.

Why TRICARE secondary claims don’t work like commercial secondary claims

Most commercial payers restart the secondary clock from the primary’s payment date. That’s the rule billers carry in their heads, and it’s the reason TRICARE secondary claims get filed late by people who did everything else right.

TRICARE doesn’t restart. The one-year limit from the date of service governs the whole thing. The 90-day OHI window is a route to an exception, not a new filing period.

Compare it against how secondary claim clocks work on a commercial plan and the difference is obvious. On TRICARE, the year is the year.

TRICARE Corrected Claim Timely Filing Limit

TRICARE doesn’t publish a separate corrected-claim deadline. No contractor does. The original TRICARE timely filing limit from the date of service governs the correction, which means a correction filed at month thirteen is late no matter when the rejection came back.

A rejected claim never stopped the clock

A rejection happens before adjudication, at the clearinghouse or in the contractor’s front-end edits. No claim on file, no reason code, no adjudication.

A denial happens after adjudication. There’s a claim on file and a code attached to it.

Rejected is not filed: A rejected claim never reached adjudication, so the one-year clock never stopped. A denied claim did, and it comes with a reason code you can work.

Send a correction against a rejection and you’re still counting from the original date of service. Practices find this out when CO-29 arrives on something their system logged as a corrected claim. Our breakdown of rejected versus denied claims covers the same trap across other payers.

How to file a corrected TRICARE claim

Electronic, on an 837I or 837P: find Loop 2300, segment CLM05-3, and enter frequency code 7 to replace the prior claim or 8 to void it. REF01 gets F8. REF02 gets the original claim number.

Paper CMS-1500: frequency code goes in Box 22, left justified, with the original claim ID in the Original Reference Number field.

Paper UB-04: the code goes in the third digit of the Box 4 type of bill, and the original claim ID goes in Box 64.

Getting the resubmission code placement wrong sends the claim down the wrong workflow, and the days keep running against the original date of service while it sits there.

Corrected claim or appeal? Pick the right route first

Bad data on the original claim means you file a correction. Disagreement with how TRICARE processed an accepted claim means you file a reconsideration.

Send a replacement claim against a payment determination and nothing happens to the decision. You’ve burned two weeks and the claim comes back the same way.

TRICARE Appeal and Reconsideration Deadlines

Reconsideration comes first, and it runs 90 days

A reconsideration is your first move on a processed claim you disagree with. You have 90 days from the date on the remittance advice, the PRA or ERA, and every disputed item needs its own request.

The reconsideration clock: 90 days from the date on the remittance advice, not from the date of service.

Watch the routing on this one. TriWest takes claim reconsiderations at TRICARE West Provider Correspondence, PO Box 2748, Virginia Beach, VA 23450, fax 1-866-852-1969. That’s a different box and a different fax number from where West appeals go, and mail sent to the wrong one comes back late.

The full appeal ladder

A factual appeal, which is what a timely filing denial is, moves through three levels with two dollar thresholds most billers have never seen.

TRICARE factual appeal levels, deadlines, and thresholds

Level

Deadline

Measured from

Threshold to advance

Appeal to contractor

90 days

Date on the EOB or decision

$50 or more to reach formal review

Formal review by DHA

60 days

Date on the appeal decision

$300 or more to reach a hearing

Independent hearing

60 days

Date of the formal review decision

Final decision by the DHA director

Level two goes to the Defense Health Agency, not to your regional contractor and not to a TRICARE Area Office. Appeals, Hearings, and Claims Collection Division, 16401 E. Centretech Parkway, Aurora, CO 80011-9066.

Under $50 in dispute, the contractor’s decision is final. Under $300 after formal review, the DHA decision is final.

Source: TRICARE factual appeals

Timely filing denials are a reviewable issue

TriWest names timely filing denials outright as an issue eligible for claim review. That single line changes how you treat a CO-29 stack.

A timely filing denial isn’t automatically a write-off. It’s disputable when you can show the claim arrived on time, the contractor counted from the wrong date, or a waiver condition applies.

Sitting on a pile of TRICARE denials and not sure which ones are still worth working? That’s a documentation review, not an appeal, and it’s worth doing before the 90 days runs out. Denial management services sort recoverable from dead before anyone spends a day building a packet nobody will read.

TRICARE Timely Filing Waiver: The Six Exceptions

Active Duty Service Members are exempt

Active Duty is exempt: The timely filing guideline doesn’t apply when the beneficiary is an Active Duty Service Member on the date of service.

Humana Military publishes this for TRICARE East, and DHA manual guidance handles service member claims separately from the standard deadline.

Here’s what that means for your aged AR. An ADSM claim sitting past a year isn’t automatically dead. Most billers write these off because every general timely filing reference says one year with no carve-out, and the carve-out is the one thing they never read. Check the claim type before the write-off posts.

The six conditions that qualify

Pull both regional criteria together and six conditions qualify for a waiver of the TRICARE timely filing limit:

  1. Retroactive eligibility or preauthorization issued after the filing deadline passed
  2. Administrative error by the contractor
  3. Inability to communicate, or mental incompetency, with no legal guardian appointed on the date of service
  4. Delayed adjudication by a primary insurance
  5. Dual eligibility with Medicare, where Medicare accepted the claim as timely
  6. The claim was submitted before the deadline and already carries a claim number

Three disqualifiers sit underneath those, and no commercial source explains any of them.

A retroactive determination issued inside the one-year window doesn’t qualify. The original year still binds. Once the deadline has passed, the claim has to be filed within 180 days of the determination date.

An administrative error claim has to be filed within 90 days of the date you were notified of the error, with a clear causal line between the error and the late filing.

The mental incompetency exception can’t be granted if a legal guardian was appointed before the deadline and the deadline was still missed.

Retroactive eligibility usually traces back to a credentialing gap rather than a claims problem, so provider credentialing and enrollment is where that one gets fixed permanently.

Source: TRICARE Operations Manual, Chapter 8, Section 3 (Change 152, September 3, 2025)

The six-year outer limit

Six years is the outer wall: Once an exception is granted, only services received in the six years immediately preceding the request can be considered. Anything older is denied.

There’s no time limit on submitting a written exception request before a claim has been filed. The six-year ceiling applies after.

Source: TRICARE East waiver form

How to request a timely filing waiver

Step 1. Confirm which condition applies. If none of the six fits, stop. A waiver request without a qualifying condition burns a cycle and comes back denied.

Step 2. Assemble the documentation that condition requires. Retroactive eligibility needs a copy of the determination. Mental incompetency needs a physician’s statement with dates, diagnoses, and treatment, attached to every claim submitted. An OHI delay needs the primary EOB showing its process date.

Step 3. Complete the claim form. An exception request without a completed claim form gets returned. Providers file on CMS-1500 or UB-04; DD Form 2642 is the beneficiary’s form, not yours.

Step 4. Route it to the right contractor.

Timely filing waiver submission by region

Region

Send to

Fax

TRICARE East

TRICARE East Region New Claims, PO Box 202146, Florence, SC 29502-2146

877-489-0007

TRICARE West

TRICARE West Correspondence, PO Box 2748, Virginia Beach, VA 23450

866-852-1969

TRICARE For Life

WPS TRICARE For Life, or online through the Message Center

Not published

Submitting the form doesn’t guarantee payment. It buys the claim a review it wouldn’t otherwise get.

TRICARE East vs TRICARE West: Where the Waiver Rules Differ

The deadline is federal and identical. The published waiver criteria are not.

Humana Military lists five conditions for the East Region plus the Active Duty exemption and the six-year ceiling. TriWest lists four for the West, including one the East doesn’t publish at all. Work both regions off a single checklist and you’ll argue the wrong exception to the wrong reviewer.

Published timely filing waiver criteria, TRICARE East compared to TRICARE West

Waiver condition

TRICARE East

TRICARE West

Retroactive eligibility or preauthorization

Published

Published

Mental incompetency, no legal guardian

Published

Published

Administrative error by the contractor

Published

Not listed

Dual eligible, Medicare accepted as timely

Published

Not listed

Claim submitted before the deadline

Not listed

Published, claim number required

Primary insurance delay

Published, no window stated

Published, 90 days from OHI decision

Active Duty Service Member exemption

Published

Not stated

Six-year outer limit

Published

Not stated

Waiver routing

PO Box 202146, Florence SC, fax 877-489-0007

PO Box 2748, Virginia Beach VA, fax 866-852-1969

"Not listed" means that contractor does not publish the condition. It does not mean the condition is disallowed. Both regions operate under the same federal exception categories in 32 CFR 199.7(d)(2).

The difference is what each contractor puts in writing, and what they put in writing is what their reviewers work from. Argue an administrative error to TriWest and you’re arguing a federal category their published criteria never mention. Bring the regulation with you.

What Happens When You Miss the TRICARE Filing Deadline

CO-29 and what it actually means

TRICARE denies claims received after the deadline, and the remittance carries CO-29, the claim adjustment reason code for an expired filing time limit. The CO group code puts the balance on your side, not the patient’s.

Systems render it inconsistently. CO29 on one screen and CO-29 on another are the same adjustment.

CO-29 is a conclusion, not a fact: It means the contractor’s records show the claim arrived late. Test the arithmetic behind it before anything gets written off.

Contractors apply the wrong plan, the wrong trigger date, or the wrong receipt date often enough that ten minutes of verification pays for itself. Check the date of service, the stated receipt date, the denial date, and the claim status history showing rejection against acceptance. Our CO-16 denial code fixes guide walks the same verification pattern on a different code.

Can you bill the patient? Read this carefully

No single rule covers every permutation of network, non-network, participating, and non-participating status here, and anyone telling you otherwise is guessing.

What’s documented: participating-claim signature language restricts balance billing for covered services under the participating arrangement, and TRICARE prohibits balance billing as a general practice. Non-participating providers face a 15% ceiling above the allowable charge by federal law.

Where that leaves a CO-29 write-off depends on your participation status and the specific claim. Check the participation agreement before anyone bills a patient for a deadline your practice missed.

When a CO-29 is worth working

A CO-29 says you blew the TRICARE timely filing limit. Test that claim before you accept it. Work it when one of these is true:

  • You hold claim-level acceptance evidence with a TRICARE claim number
  • The contractor counted from the wrong clock-start date
  • One of the six waiver conditions applies to the claim
  • The claim was rejected rather than denied, and the rejection was the contractor’s error

Leave it alone when the claim never reached adjudication, you have no acceptance record, and no waiver condition fits. Knowing which stack is dead is worth as much as knowing which stack is recoverable, because it stops three weeks of work on claims nobody will pay.

Looking at a CO-29 on a TRICARE remittance right now? The first question is whether a waiver condition applies, and that is a documentation review rather than an appeal. Root-cause denial recovery works the filing period, the acceptance evidence, and the denial reason before anything gets submitted, and tells you straight when a claim isn’t recoverable.

How to Prove Timely Filing to TRICARE

What counts as proof, strongest to weakest

Proving you met the TRICARE timely filing limit comes down to what you can document, and not every document carries the same weight with a reviewer.

Proof of timely filing evidence, ranked by strength

Evidence

What it establishes

Claim-level acceptance with a TRICARE claim number

The contractor received and accepted this specific claim

Accepted 277CA acknowledgment

Claim-level acknowledgment of that claim

Clearinghouse transmission report with date and confirmation number

The claim left your system on a given date

Certified mail receipt

A paper claim was mailed on a given date

Internal billing system timestamp

Weakest. Shows intent, not receipt

The order matters more than the list. A clearinghouse acceptance report is not a payer claim number, and billers submit the weaker one constantly because it’s the easier one to pull.

Any written request can establish the filing date

Any written request counts: A written request for benefits establishes the filing date even when it isn’t on an approved claim form. The approved form still has to follow.

Correspondence sent before the deadline can preserve timeliness while you chase down documentation. Almost nobody uses this, because almost nobody knows it exists.

Source: TRICARE Operations Manual, Chapter 8, Section 3

Build the packet before you need it

Download and store clearinghouse transmission records on a schedule. Most clearinghouses retain them 12 to 24 months, which sounds generous until a TRICARE claim denies at month thirteen and the record aged out two weeks earlier.

Save the 277CA. Attach the acceptance report to the claim record itself, not to a general folder nobody can search fourteen months from now.

Claims submission tracking produces this evidence as a byproduct of daily submission, which beats reconstructing it under deadline pressure. The proof-of-filing evidence hierarchy works the same across other payers.

How to Stop Losing TRICARE Claims to the Filing Deadline

File within 30 days, not 300

TriWest recommends filing within 30 days of service, and that recommendation exists for a reason. The TRICARE timely filing limit is a boundary, not a plan.

A claim submitted on day 30 has eleven months of runway for rejections, corrections, and OHI coordination. A claim submitted on day 300 has 65 days and no room for a single rejection cycle.

Set alerts at 180, 270, 300, and 330 days

Standard aging alerts don’t work on TRICARE. A claim can sit for six months and still be well inside its deadline, so the 60-day and 90-day flags everyone runs never fire on it, and nobody looks at it until the year is nearly gone.

Long deadlines hide dying claims: A 90-day aging alert never fires on a TRICARE claim until the window is almost closed. Set the alerts to the payer, not to the report.

Build TRICARE-specific alerts at 180, 270, 300, and 330 days post-date-of-service, with a parallel set running post-discharge for inpatient facility bills. AR follow-up by aging bucket works claims by deadline proximity rather than by age alone, which is the only way a 365-day payer gets handled correctly.

Review clearinghouse rejections daily

A claim that fails at the clearinghouse never reached the contractor, and the clock keeps running the entire time it sits in the rejection report.

Leave that report unreviewed for two weeks and you’ve spent two weeks of runway on every claim in it. Daily review is the highest-return habit in timely filing prevention, and it costs one person about twenty minutes.

Flag Active Duty and overseas claims separately

Two claim types need their own queue.

Overseas dates of service run on a three-year window, so working them on the same aging logic as domestic claims either wastes effort early or buries them late. Active Duty claims may not be subject to the deadline at all, and a standard aging rule writes them off automatically.

Both of these get handled correctly inside full revenue cycle management because the queue logic gets built around the payer instead of the calendar.

Working TRICARE Claims Without a Full Billing Department

What TRICARE-specific billing support actually covers

TRICARE billing breaks generic billing workflows in seven predictable places, and the TRICARE timely filing limit is only the first of them.

Region routing between Humana Military and TriWest determines the payer ID, 99727 or 99726, and a claim sent to the wrong one rejects without ever reaching adjudication. Secondary claims run two clocks at once. Active Duty claims need flagging out of standard aging before the write-off rule catches them. Overseas dates of service belong in a separate three-year queue.

Waiver documentation gets assembled by condition, because the physician’s statement that supports mental incompetency does nothing for an administrative error claim. CO-29 denials get tested against the contractor’s own arithmetic before anyone writes them off. Corrected claims get routed as corrections rather than as disputes.

None of that is exotic. It’s specialized, and a generalist billing workflow misses it because TRICARE looks like Medicare until the moment it doesn’t.

What it costs

What MedSole RCM charges: Full-service revenue cycle management runs 2.99% of monthly collections, with no setup fee, no per-claim charge, and no long-term contract. Provider credentialing runs $99 per insurance enrollment.

Most medical billing companies charge 4% to 7% of collections, and many add setup fees, per-claim charges, and monthly minimums on top of the percentage. At $50,000 in monthly collections, 2.99% comes to $1,495. At 6%, the same practice pays $3,000 before a single add-on.

Credentialing at $99 per enrollment covers CAQH profile creation and attestation, application submission with documentation review before it goes out, weekly payer follow-up, recredentialing deadline tracking, and status updates through approval. Typical enrollment runs 30 to 90 days.

Denial management and AR follow-up run 4.49% of what gets recovered as standalone services, or carry no separate charge inside the 2.99% rate. A practice holding a stack of TRICARE denials doesn’t need a second vendor to work them.

MedSole RCM runs all of it inside the EHR your practice already uses, with no platform change and no data migration.

If TRICARE claims are aging past 300 days and nobody has the bandwidth to work them, that’s fixable. Send the aging report and we’ll tell you what’s still recoverable before you commit to anything.

TRICARE Timely Filing FAQs

What is the TRICARE timely filing limit?

One year from the date of service, or one year from the inpatient discharge date for facility charges billed by the facility. Overseas claims get three years from the date of service or discharge. Dental and pharmacy claims each carry their own one-year window. Claims received after the deadline deny with CO-29, and the balance falls to the provider rather than the patient. The deadline comes from federal regulation at 32 CFR 199.7, so no contractor can shorten or extend it by contract.

What is the TRICARE timely filing limit for corrected claims?

TRICARE doesn’t publish a separate corrected-claim deadline. The original one-year limit from the date of service governs the correction, which means a correction submitted at month thirteen is late regardless of when the rejection came back. A rejected claim matters here: rejections happen before adjudication, so the clock never stopped. File corrections electronically with frequency code 7 in Loop 2300, segment CLM05-3, and put the original claim number in REF02.

What is the TRICARE timely filing limit for appeals?

A factual appeal goes to your regional contractor within 90 days of the date on the explanation of benefits. If the disputed amount is $50 or more and the decision letter names the Defense Health Agency as the next level, you can request a formal review within 60 days. Disputes of $300 or more can go to an independent hearing within 60 days of the formal review decision. Timely filing denials are an appealable issue, not an automatic write-off.

What is the TRICARE For Life timely filing limit?

One year from the date of service, the same as every other TRICARE region. Medicare files first on every TRICARE For Life claim, and WPS processes the TRICARE portion. Medicare accepting your claim as timely is an exception pathway you request, not an automatic reset of the filing clock. A claim filed a year after the date of service is late even when the Medicare EOB arrived last week. Track the date of service, not the crossover date.

What is the TRICARE timely filing limit for secondary claims?

Two deadlines run at once. The one-year window from the date of service keeps running, and the claim also has to reach TRICARE within 90 calendar days of the other insurer’s adjudication date. Whichever closes first controls the claim. When a primary payer takes longer than a year to adjudicate, that 90-day window becomes the basis for a waiver request rather than a filing right. The primary EOB has to show beneficiary liability, billed amount, and allowed amount.

Are Active Duty Service Members exempt from TRICARE timely filing?

Yes. Humana Military publishes that the timely filing guideline doesn’t apply when the beneficiary is an Active Duty Service Member on the date of service, and DHA manual guidance treats service member claims separately from the standard deadline. An ADSM claim sitting past a year in aged AR isn’t automatically unrecoverable. Verify the claim type and the beneficiary’s status on the date of service before the write-off posts, because a standard aging rule will close it out.

How do I request a TRICARE timely filing waiver?

Confirm which of the six exception conditions applies, assemble the documentation that condition requires, complete the claim form, and route it to your contractor. East goes to TRICARE East Region New Claims, PO Box 202146, Florence, SC 29502-2146, fax 877-489-0007. West goes to TRICARE West Correspondence, PO Box 2748, Virginia Beach, VA 23450, fax 866-852-1969. Submitting the request doesn’t guarantee payment, and services older than six years are denied even when the exception is granted.

What happens if a TRICARE claim is filed late?

The claim denies with CO-29, the reason code for an expired filing time limit. Before writing it off, test the contractor’s arithmetic against the actual date of service, the stated receipt date, and the claim status history, because contractors apply the wrong trigger date often enough to make the check worthwhile. Then check the six waiver conditions. Whether the balance can be billed to the patient depends on your participation status and the specific claim.

When a correction is the wrong route and an appeal is the right one, corrected claim or appeal routing lays out the decision the same way across payers.

Sources

About the Author
Andrew Christian

Andrew Christian

Billing Manager

Andrew Christian is the Billing Manager at MedSole RCM, bringing 12+ years of experience in medical billing, coding, and revenue cycle management across multiple specialties. He is highly skilled in claims submission, denial management, payment posting, and payer follow-up, ensuring maximum reimbursement for providers. Andrew works closely with Medicare, Medicaid, and commercial payers, supporting hundreds of providers nationwide. His proven billing approach minimizes claim rejections, accelerates cash flow, and drives stronger financial performance from day one.