What is Tricare (Military Health System / DHA)'s timely filing limit for initial claims?

Tricare (Military Health System / DHA) enforces an initial claim timely filing deadline of 1 calendar year (365 days) from Date of Service.

How many days do you have to appeal a denial with Tricare (Military Health System / DHA)?

Appeals and payment disputes with Tricare (Military Health System / DHA) must be filed within 90 calendar days from the date on the explanation of benefits (EOB).

What is the secondary claim timely filing limit for Tricare (Military Health System / DHA)?

Secondary claims for Tricare (Military Health System / DHA) must be submitted within 1 calendar year from Date of Service or 90 days from primary EOB.

Tricare Military & Defense Health Agency 365 Days Limit

Tricare (Military Health System / DHA) Timely Filing Limit & Appeal Deadlines

Official filing rules, submission windows, appeal timeframes, and acceptable electronic clearinghouse proof for billing Tricare (Military Health System / DHA).

Initial Claim Limit

365 Days from DOS

Secondary Claim Limit

365 Days from EOB

Level 1 Appeal Limit

90 Days

Level 2 Dispute Limit

60 Days

1. Initial Claim Submission Deadline

1 calendar year (365 days) from Date of Service

Clean electronic 837P or 837I claims must be received and acknowledged by Tricare (Military Health System / DHA) within this window. If a claim is rejected on front-end clearinghouse validation (Level 2), it is not considered received by Tricare (Military Health System / DHA) until corrected and successfully re-transmitted.

2. Specific Filing Rules for Tricare

Initial claims must be received within 1 year from the date of service or 1 year from the date of inpatient discharge.

Secondary claims require primary EOB; if primary takes >1 year, must submit within 90 days of primary EOB.

Appeals have a strict 90-day window from the EOB date.

3. Accepted Proof of Timely Filing

Official Proof Required by Tricare

Clearinghouse 277CA acceptance acknowledgment, Tricare East (Humana Military) or Tricare West (Health Net Federal) web portal receipt.

Important: Screenshots from your internal billing software or electronic health record (EHR) showing the date a claim was created are not accepted by Tricare as proof of submission. You must supply clearinghouse 277CA acceptance reports.

4. Appeal Letter Template for Tricare

Use this standardized appeal letter to overturn a CO-29 timely filing denial when you have verifiable clearinghouse proof:

RE: Timely Filing Denial Appeal (CO-29)
Payer: Tricare (Military Health System / DHA)
Patient Name: [Patient Name] | Member ID: [Member ID]
Date of Service: [Date of Service] | Claim ID: [Claim Number]
Billed Charges: $[Billed Amount]

Dear Appeals Coordinator,

We are submitting this formal appeal in response to the timely filing denial (CO-29) issued on the Explanation of Benefits dated [Remittance Date]. Under our participating agreement with Tricare (Military Health System / DHA), the timely filing limit is 365 calendar days from the date of service.

The original claim was electronically transmitted and received prior to the timely filing limit expiration. Enclosed please find Exhibit A: The clearinghouse Electronic Data Interchange (EDI) 277CA Claims Acknowledgment Report confirming successful gateway acceptance on [Date of Initial EDI Transmission] with Payer Claim Control Number [ICN / CCN].

Because this documentation constitutes conclusive objective proof of timely electronic submission, we respectfully request that the claim be reprocessed and approved for reimbursement.

Sincerely,
[Billing Manager / Practice Representative]
[Practice Name]
[Phone Number]