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T2017 TRI CARE West EFT/ERA PO Box 870156 Surf side Beach, SC 295879756 Fax: 18882822841 Attn: T2017 West EFT/ERA Enrollment Form PROVIDER INFORMATION Provider Name PROVIDER ADDRESS Street ZIP Code/
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01
To fill out the T2017 Tricare West Eftera form, follow these steps:
02
- Start by entering the beneficiary's personal information, such as name, date of birth, and Social Security number.
03
- Next, provide the sponsor's information, including name, rank, and affiliation with the military.
04
- Fill in the details of the medical provider or facility where the services were rendered.
05
- Specify the dates of service and the type of treatment or procedure received.
06
- Indicate the expenses incurred and the amount paid for each service.
07
- If applicable, attach any supporting documents, such as receipts or medical records.
08
- Review the form for accuracy and completeness before submitting it.
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- Finally, sign and date the form to certify its accuracy.
Who needs t2017 tricare west eftera?
01
The T2017 Tricare West Eftera form is needed by individuals who have received medical services in the Tricare West region and are seeking reimbursement for those expenses.
02
It is typically used by beneficiaries who are enrolled in Tricare West and have received care from non-network providers or have paid out-of-pocket for covered services.
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What is t2017 tricare west eftera?
t2017 tricare west eftera is the name of the form used for reporting healthcare coverage provided through Tricare West for the year 2017.
Who is required to file t2017 tricare west eftera?
Individuals who had Tricare West healthcare coverage in 2017 are required to file t2017 tricare west eftera.
How to fill out t2017 tricare west eftera?
t2017 tricare west eftera can be filled out electronically or by mail using the information provided by Tricare West. It requires reporting details of the healthcare coverage for the year 2017.
What is the purpose of t2017 tricare west eftera?
The purpose of t2017 tricare west eftera is to report healthcare coverage provided through Tricare West for the year 2017 to ensure compliance with tax regulations.
What information must be reported on t2017 tricare west eftera?
t2017 tricare west eftera requires reporting the name of the individual covered, the duration of coverage, and any other relevant details of the healthcare coverage provided through Tricare West.
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