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Forms

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Claim Forms

Authorizations

  • Service Request Notification For Authorization:
    Request for other services that require authorization besides Skilled Nursing Facility. For a list of other services that require authorization see the authorization section of this website.

Refunds

  • Refund Information Request Form:
    Request for refund - needs to be submitted with a copy of the WPS Explanation of Benefits (EOB) to: WPS/TRICARE For Life P.O. Box 7928 Madison, WI 53707-7928

Skilled Nursing

Waivers

Electronic Data Interchange (EDI) Forms

Provider Certification Forms

Overseas Region - The Overseas Region link will route you to the International SOS website.
West Region - The West Region link will route you to the United Healthcare website.
North Region - The North Region link will route you to the Health Net Federal Services website.
South Region - The South Region link will route you to the Humana Military website.
Express Scripts - The Express Scripts link will route you to the Express Scripts TRICARE website.