Claim Appeals

Only charges denied because the service is not covered by TRICARE or not medically necessary may be appealed. Your TRICARE Explanation of Benefits (EOB) or provider remittance will indicate if a denied charge is appealable. If the denial note does not indicate the charge can be appealed, you may request a claim review instead of an appeal.

Note: Only Point of Service (POS) charges for emergency care can be appealed. Visit our Disputing Point of Service Charges page to review other scenarios for disputing POS charges.

Who can appeal a denied claim?

How do you submit a claim appeal?

A claim appeal must be filed in writing within 90 days of the date on the EOB or provider remittance. You may use the online appeal submission form below or submit an appeal letter via mail or fax.

Online option. Complete our online appeal form. You will be able to print a preview of your appeal before it is submitted and a copy of the submitted appeal with a tracking number.


Mail/fax option.
Mail or fax the written claims appeal and supporting documentation. There is no specific appeal form required. Be sure to include the following:

Health Net Federal Services, LLC
TRICARE Claim Appeals
PO Box 8008
Virginia Beach, VA 23450-8008
Fax: 1-844-802-2527

Be sure to send supporting documentation within 10 days from submission via fax (or postal mail if sending color photos).

What is the processing time for claim appeal?

A reply from Health Net Federal Services, LLC (HNFS) will usually be sent within 30 days of receiving the appeal. If the denial is upheld or partially upheld, and next level appeal rights are available, they will be given in the appeal determination letter. If the denial is overturned the claims will be reprocessed within 21 days of the appeal determination.

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