Back to Top Skip to main content the official website of the Military Health System (MHS) and the Defense Health Agency (DHA)

Utility Navigation Links

TRICARE Operations Manual 6010.59-M, April 1, 2015
TRICARE Dual Eligible Fiscal Intermediary Contract (TDEFIC)
Chapter 20
Section 2
1.0  Regional Boundaries
1.1  For claims processing jurisdiction purposes, TRICARE regional boundaries do not apply under the TRICARE Dual Eligible Fiscal Intermediary Contract (TDEFIC). The TDEFIC contractor shall be responsible for processing all medical claims for services, except retail pharmaceuticals, rendered to TRICARE/Medicare dual eligible individuals within the 50 United States (U.S.) and the District of Columbia, as well as Puerto Rico, Guam, the U.S. Virgin Islands, American Samoa, and the Northern Mariana Islands.
1.2  Medicare claims processing jurisdiction is based on place of service. The TDEFIC contractor shall contract with the Medicare Coordination of Benefits Contractor (COBC) to ensure that Medicare claims for all TRICARE dual eligible beneficiaries receiving care within the respective carrier’s/FI’s state(s) are electronically forwarded to the TDEFIC contractor. The cross-over claims agreement shall include all TRICARE dual-eligible beneficiaries regardless of the beneficiary’s status (Active Duty Dependent, retiree, survivor, etc.).
- END -

Utility Navigation Links

DoD Seal is the official website of the Defense Health Agency (DHA) a component of the Military Health System

TRICARE is a registered trademark of the Department of Defense (DoD), DHA. All rights reserved.

CPT only © 2006 American Medical Association (or such other date of publication of CPT). All Rights Reserved.

If you have a question regarding TRICARE benefits, please go to the TRICARE Contact Us page page.
If you need help with technical/operational issues, please go to the TRICARE Manuals Online Help page.

The appearance of hyperlinks to external websites does not constitute endorsement by the DHA of these websites or the information, products or services contained therein. For other than authorized government activities, the DHA does not exercise any editorial control over the information you may find at other locations. Such links are provided consistent with the stated purpose of this DoD website.


DHA Address: 7700 Arlington Boulevard | Suite 5101 | Falls Church, VA | 22042-5101

Some documents are presented in Portable Document Format (PDF). A PDF reader is required for viewing. Download a PDF Reader or learn more about PDFs.