DDFORMS.ORG – DD Form 2569 – Third Party Collection Program/Medical Services Account/Other Health Insurance – A third-party collection program medical services account (TPCLIMSA) is a special account that is used by the taxpayer to record payments made to Medicare, Medicaid, or other third-party medical service providers. TPCLIMSA should be used to report payments for services rendered on IRS Form 1094, Healthcare Providers Statement.
Download DD Form 2569 – Third Party Collection Program/Medical Services Account/Other Health Insurance
| Form Number | DD Form 2569 |
| Form Title | Third Party Collection Program/Medical Services Account/Other Health Insurance |
| Edition Date | 11/1/2022 |
| File Size | 72 KB |
What is a DD Form 2569?
A DD Form 2569 is a document used by the military to collect medical fees from third-party insurers. The Third Party Collection Program (TPCP) is a program that allows the Department of Defense to collect reimbursement for medical expenses incurred by military personnel and their families when care is provided in civilian facilities. When military beneficiaries receive care from civilian providers, they are required to provide information about any other health insurance coverage they have.
The DD Form 2569 is the form that’s used to collect this information. Once the form has been completed, it enables the military to bill other insurance companies for services rendered. This includes private insurance plans or Medicare and Medicaid, among others. The TPCP helps ensure that military healthcare costs are reimbursed appropriately while minimizing costs for taxpayers and ensuring that service members can access high-quality healthcare no matter where they are stationed around the world.
Where Can I Find a DD Form 2569?
DD Form 2569 is a crucial document for military personnel and their families. This form is used to track medical expenses that are not covered by TRICARE, the Department of Defense’s healthcare program. The DD Form 2569 helps active-duty personnel and their dependents obtain reimbursement from other health insurance providers or to bill patients when necessary. It also helps to reduce the overall cost of military healthcare.
You can find a DD Form 2569 at any Military Treatment Facility (MTF), which includes hospitals, clinics, and dental facilities. If you are stationed overseas, you can reach out to your local MTF or contact the TRICARE Overseas Program Regional Call Center for assistance in obtaining this form. You can also download the form from the Defense Health Agency’s website by searching for “DD Form 2569” in their search bar.
It’s important to note that completing this form requires careful attention to detail and accuracy, as it affects billing and reimbursement processes. Therefore, it may be helpful to seek guidance from your MTF or consult with a financial advisor who specializes in military finances. By properly filling out DD Form 2569, you can ensure that your medical expenses are accurately recorded and appropriately reimbursed through other health insurance providers or paid directly by patients when necessary.
DD Form 2569 – Third Party Collection Program/Medical Services Account/Other Health Insurance
The DD Form 2569 is a document that is used by the Department of Defense to collect payments from third-party health insurance providers for medical services provided to military personnel and their families. This form is used under the Third Party Collection Program, which aims to recover costs incurred by the government in providing healthcare services to beneficiaries who have other insurance options. The DD Form 2569 is specifically designed for use with Other Health Insurance (OHI) plans.
The primary purpose of the DD Form 2569 is to identify any OHI coverage that a patient may have and bill those insurers for any medical services provided. This allows military medical facilities and providers to receive reimbursement for these services, thus reducing the overall cost burden on taxpayers. The form also helps ensure that patients receive needed care without worrying about paying out-of-pocket expenses upfront.
Overall, the DD Form 2569 plays an essential role in ensuring that military personnel and their families have access to quality healthcare while also reducing costs through effective collection practices. By leveraging OHI plans and third-party payers, the government can continue providing comprehensive medical care to those who serve our country without placing undue financial strain on either party involved.
DD Form 2569 Example
