Get the free LC-7363-0 TRICARE Statement of claim & auth to release ... - EBView

Fleet Reserve Association Health Insurance Claim Form Before completing, please read all instructions carefully to insure fast, accurate processing. INSTRUCTIONS ON HOW TO SUBMIT A CLAIM FORM 1. The

How to fill out lc-7363-0 tricare statement of

How to fill out lc-7363-0 Tricare statement of:

1. Start by downloading the lc-7363-0 Tricare statement of form from the official Tricare website or request a copy from your healthcare provider.
2. Read the instructions carefully to understand the purpose and requirements of the form.
3. Begin filling out the personal information section, including your name, contact information, and Tricare identification number.
4. Provide the details of the medical provider or facility that rendered the services. This may include their name, address, and contact information.
5. Indicate the date(s) of service for which you are submitting the Tricare statement of. Be sure to include the exact dates and any relevant timeframes.
6. Describe the medical services provided in detail. This may include the diagnosis, treatment, medications, tests, or any other pertinent information.
7. If applicable, include any supporting documentation. This may consist of receipts, invoices, or medical records that validate the services provided.
8. Review the completed form thoroughly to ensure all the required fields are filled accurately and completely.
9. Sign and date the form to certify the information provided is true and correct.
10. Keep a copy of the completed form for your records before submitting it to Tricare.

Who needs the lc-7363-0 Tricare statement of:

1. Active-duty service members who received healthcare services outside of a military treatment facility (MTF) and wish to get reimbursed by Tricare.
2. National Guard or Reserve members who were on active duty orders and received healthcare services outside of an MTF.
3. Family members of active-duty service members or retirees who received healthcare services outside of an MTF and wish to get reimbursed by Tricare.
4. Retirees or their family members who received healthcare services outside of an MTF and wish to get reimbursed by Tricare.
5. Survivors of deceased active-duty service members who received healthcare services outside of an MTF and wish to get reimbursed by Tricare.

Note: The lc-7363-0 Tricare statement of is used for reimbursement purposes and should be completed accurately and timely to ensure prompt processing of claims.

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