Military Medical Support Office at Defense Health Agency, Great Lakes

The Military Medical Support Office at Defense Health Agency–Great Lakes authorizes medical care in the U.S., District of Columbia, and U.S. Virgin Islands for:

  • Active duty service members enrolled in TRICARE Prime Remote
  • Service members, active and reserve, enrolled in TRICARE Prime who don't have an assigned primary care manager
  • Reserve Component service members in remote areas with a Service-connected line of duty injury, illness or disease
  • Service members properly referred to Veteran's Affairs medical facility for care under the DOD/VA Memorandum for Agreement for a Spinal Cord Injury, Traumatic Brain Injury, or Blindness

Are you in a remote location?

A remote location is 50 miles or an hour's drive time from a military hospital or clinic. If you're not sure, go to the Military Hospital and Clinic LocatorOpens in TRICARE website:

  • Enter your home ZIP code
  • Change mileage to 75 miles

What We Do

As a branch of the DHA TRICARE Health Plan directorate, the MMSO:

  • Provides authorizations for civilian health care services for service members listed above.
  • Reviews and authorizes certain specialty care referrals for TPR-enrolled service members.
  • Collaborates with Reserve/National Guard unit representatives regarding Line of Duty care for their service members in remote locations
  • Provides authorization (pre-, concurrent and retro-) for active duty service members accepted for VA medical care under the DOD/VA MOA for diagnosis for SCI, TBI, or blindness
  • Authorizes the payment of civilian medical claims for certain service members

 

Frequently Asked Questionsgoes to FAQs

 

Line of Duty Episode of Care Authorizations

THP MMSO authorizes treatment of a specific LOD medical condition to include:

  • Diagnostic tests
  • Durable medical equipment support
  • Treatment (to include surgery, if indicated) and
  • Any required/related follow-on care. Follow on care includes:
    • physical therapy
    • follow-on testing

There is no longer a requirement for incremental requests to authorize care for each step in the treatment process. Episode of Care authorizations result in a better coordinated treatment process for the RC servicemember and reduces delays in providing needed care.

Under EOC, referred to as evaluate and treat, the PCM/specialty care provider manages the entire episode of care to include diagnostics, treatment, and follow-on care. THP MMSO does not select PCMs, the TRICARE contractor does.

THP MMSO initiates the referral/preauthorization request directly to the respective TRICARE regional contractor through the government portal. Once the TRICARE contractor receives the referral, they provide an authorization directly to a PCM or specialty provider for the services requested. 

The member and/or the unit may see these authorizations once completed on the TRICARE contractor’s authorization self-service portal:

It is the service member’s responsibility to keep the Unit informed on the status of their care throughout the entire EOC treatment process.

Most LOD follow-on care pre-authorizations issued by THP MMSO are 365-day EOC authorizations. LOD care can only be approved for maximum of 12 months. If eligible, service members can seek additional care through the VA. The service member also should be referred to the Disability Evaluation System.

Submitting Documents to DHA-GL

Medical Eligibility Documentation

Medical eligibility documents are used to document, establish, manage, and authorize civilian health care for eligible Reservist, and National Guard members who incur or aggravate an injury, illness or disease in the line of duty.

Reservist and National Guard members who incur or aggravate an injury, illness or disease in the line of duty on orders under 30 days.
(For emergency room/urgent care visits only)

Submitting Eligibility

Follow these steps to forward medical eligibility documentation to DHA-GL.

Step Action
1

Unit medical representative completes package for Medical Eligibility (DHA-GL Worksheet-01).

  • Block 16 MUST be CAC verified with a digital signature.
  • Certified copy of orders/drill attendance
  • ER/Urgent care notes (Not discharge notes or after visit summary)
2

Army Reserve and Army National Guard MUST submit eligibility documents through eMMPS/MEDCHART.

For all other branches of service, the unit medical representative submits the medical eligibility package with DHA-GL Worksheet 01: Medical Eligibility Verification to the following email (preferred), fax, or address:
3

Ensure provider submits claims to appropriate region and uses the service members SSN as the member ID number on the medical claim.

Do not send bills, claims, invoices, etc. to DHA-GL. All claims and billing must be submitted to TRICARE.

TRICARE East
Claims Department
P.O. Box 202146
Florence, SC 29502-2146

TRICARE West
Claims Submissions
TRICARE West Claims
P.O. Box 202160
Florence, SC 29502-2160 

Note: If a service member needs follow-up medical care, see requesting "Pre-authorization for Line of Duty Care" below. The request must include a service approved Line of Duty. Any claims for medical care rendered without a pre-authorization will be denied.

Results and Follow-up

After the required medical eligibility documents have been submitted to DHA-GL the service member should have a beneficiary account with either region where they can review claims and view/print their Explanation of Benefits.

Pre-authorization for Line of Duty Care

DHA-GL pre-authorizes civilian medical care for eligible National Guard and Reservists who have been injured or became ill in the line of duty during a period of qualified duty who resides greater than 50 miles/one hour drive time from a military hospital or clinic.

You must meet the following criteria:

  • National Guard or Reservist and have been issued a Line of Duty Determination and resides outside 50 miles/one hour drive time of a military hospital or clinic.
  • Have medical eligibility documentation on file at DHA-GL prior to requesting care.

Follow these steps to receive pre-authorizations for civilian health care.

Step Action
1

Unit medical representative must complete a Pre-Authorization Request for Medical Care (DHA-GL Worksheet-02).

  • Block 18 MUST be CAC verified with a digital signature
  • Service approved LOD
  • Certified orders/attendance roster
  • Clinical documentation

Clinical documentation should validate that the medical condition was incurred or aggravated while the member was in a qualified duty status.

Most authorizations will be completed for evaluate and treatment. If evaluate and treatment may not be warranted in a certain case, please contact DHA-GL.

Exceptions to evaluate and treatment authorization will be considered on a case-by-case basis.
2

Army Reserve and Army National Guard MUST submit pre-authorization request through eMMPS/MEDCHART.

For all other branches of service, the unit medical representative submits Line of Duty package with DHA-GL Worksheet 02: Pre-Authorization Request to the following email (preferred), fax, or address:

Formal Appeals

This explains how an eligible member submits a formal appeal to DHA-GL to request:

  • Payment of a denied authorized medical care claim
  • Approval of a pre-authorization for medical care previously denied 

To be eligible to submit a formal appeal to DHA-GL, you must have been either denied a payment of medical care claim(s), or denied pre- authorization request(s) for authorized medical care, and meet the following criteria.

  • If, you're a member of the
    • National Guard
    • Reserve
  • Then on the date of care, must
    • Have an approved Line of Duty on file at DHA-GL for the illness or injury.

Appeals aren't a guarantee of claim payment or pre-authorization approval.

Follow these steps to submit a formal appeal.

Step Who Takes the Action Action
1 Member Contacts Medical/Unit Representative for clarification, guidance, and assistance with denial of claim or pre-authorization request. 
2 Member/Unit Representative

Contacts appropriate DHA-GL point of contact below via telephone for further information regarding the reason for denial. Assists member in developing appeal.

Note: If the member lives within 50 miles/one hour drive time to a military hospital or clinic then all of their care is managed by that military hospital or clinic. Contact that military hospital or clinic for appeal process.
3 Member/Unit Representative

Completes the DHA-GL Worksheet 03: Formal Appeal Request and includes:

  • Copy of the Explanation of Benefits, if applicable
  • Eligibility includes:
    • Certified orders/drill attendance sheet or
    • Service approved LOD (if not on file at DHA- GL)
  • Additional clinical documents if required. 
4 Member/Unit Representative

Email appeal request package to DHA-GL at the below address:

Examples of when appeals don't apply. This list isn't all-inclusive.

  • Non-covered services
  • Non-certified provider
  • Expired authorization
  • No service approved LOD
  • Pre-existing conditions
  • Negligence and/or misconduct
  • Service member no longer in military

Results and Follow-up

If the appeal is denied, the reason for the denial will be provided via phone call or email.

Pharmacy Reimbursement

DHA-GL in conjunction with Express Scripts began processing retail pharmacy reimbursements for members of the National Guard and Reserve on Nov. 15, 2004.

Members of the National Guard and Reserve who have pre-paid or have been billed for pharmaceuticals in conjunction with a Line of Duty Determination injury or illness.

Note: Over-the-counter drugs and any non-covered pharmaceuticals won't be reimbursed.

Follow these steps to get reimbursed for authorized pharmaceutical items:

Step What Happens
1

Member/Designated person with a Power of Attorney only completes and signs TRICARE DOD/CHAMPUS Medical Claim: Patient's Request for Medical Payment (DD Form 2642).

Ensure that the member’s SSN is on the form. 
2

Member provides claim printout or paid civilian pharmacy invoice with all the following information:

  • Doctors Name
  • Drug Name
  • National Drug Code number
  • Quantity
  • Cost share or amount charged
  • Date of service

Name of retail pharmacy and address (required). 
3

Obtain eligibility documentation that covers the date of injury and/or pharmacy, i.e. orders, attendance roster, or LOD if not already sent to/on file at DHA-GL.

Army Reserve and Army National Guard must submit eligibility through eMMPS/MEDCHART. 
4

Submit DD Form 2642, pharmacy invoice, eligibility documentation/LOD, and DHA-GL Worksheet 01: Medical Eligibility Verification to the following email (preferred), fax or address:

  • Email: dha.great-lakes.j-10.mbx.mmso-lod-misc@health.mil
  • Fax: 224-447-0152 or 224-447-0153
  • Mailing Address:
    Defense Health Agency Great Lakes (DHA-GL)
    Attn: RC Retail Pharmacy Reimbursement
    2834 Green Bay Road
    Bldg 3400 Ste 304
    Great Lakes, IL 60088 

If DHA-GL determines your pharmacy bill is related to your LOD injury or illness they will instruct ESI to process your claim for reimbursement. Within 30 business days, you should receive an Explanation of Benefits statement with a reimbursement check from ESI.

How to Obtain Debt Collections Assistance

To assist members with resolving debt collection issues, the Under Secretary of Defense established Debt Collection Assistance Officer programs at every military treatment hospital and clinic worldwide.

DCAOs assist by providing the correct regional contractor’s billing information to the provider(s)/collection agency.

While DCAOs cannot provide legal advice or act as beneficiary advocates, they will take all measures necessary to ensure each case is thoroughly researched and that beneficiaries are provided with written findings and assistance in the minimum time possible. DHA-GL cannot remove debt in collections from credit reports.

The following personnel may seek assistance via the DHA-GL DCAO to resolve debt collection issues:

If Then Member Must
National Guard or Reservist

Have been issued a Line of Duty Determination at the time of care/debt incurred.

The LOD must be on file at DHA-GL prior to requesting assistance.

If service member resides in within 50 miles/one hour drive time of a military hospital or clinic, the service member should seek assistance from the military hospital or clinic.

Follow these steps to receive assistance from the DHA-GL Debt Collection Assistance Officer:

Step What Happens
1

Member completes the:

DHA-GL must have these forms to legally contact the collection agencies involved. 
2

Member or Unit Representative should email (preferred), fax, or mail the following documentation to DHA-GL DCAO:

  • DD Form 2870
  • Notice of the Role of the DCAO
  • Copy of the final notice letter from the collection agency/credit bureau, stating this information has been noted on the member's credit report
  • LOD (if appropriate)
  • Email: dha.great-lakes.j-10.mbx.mmso-lod-misc@health.mil
  • Fax: 224-447-0152 or 224-447-0153
  • Mailing Address:
    Defense Health Agency Great Lakes DHA-GL
    Attn: Debt Collection Action Officer (DCAO)
    2834 Green Bay Rd., Bldg. 3400, Ste. 304
    Great Lakes IL 60088

If the DHA-GL DCAO does not receive all the information listed above from the member, the DCAO will send the member a letter requesting information needed to pursue the case.
3

Ensure provider submits claims to appropriate region and uses the service member's SSN and the member ID number on the medical claim.

Do not send bills, claims, invoices, etc. to DHA-GL. All claims and billing must be submitted to TRICARE

TRICARE East
Claims Department
P.O. Box 202146
Florence, SC 29502-2146

TRICARE West
Claims Submissions
TRICARE West Claims
P.O. Box 202160
Florence, SC 29502-2160

Service member must contact TRICARE to work with providers to send claim to contractor. DHA-GL/MMSO does not have authority to direct provider to bill TRICARE.

Results and Follow-up

Once a complete package is received, the DHA-GL DCAO will contact the credit bureau/collection agency and requests a 60-day hold until TRICARE pays the claim. Once paid by TRICARE, a notice goes to the credit bureau/ collection agency with information pertaining to the date of the check and check number. The letter also requests that the negative credit information be removed within 14 days.

It is the providers responsibility to notify collection agency and remove the debt from the service member’s credit report.

The service member should be actively involved and reaching out to the providers/collection agency to ensure the debt(s) have been resolved. The service member should also be registered for the online beneficiary portal to track claim status. If the care in question is not covered by TRICARE, or the member was ineligible, the DHA-GL DCAO will send a letter to the member stating the facts.

Request Worksheets

The worksheets below are submitted to the MMSO. Instructions and addresses are found on each worksheet.

FileDate
DHA-GL Worksheet 01: Medical Eligibility Verification3/15/2024
DHA-GL Worksheet 02: Pre-Authorization Request3/15/2024
DHA-GL Worksheet 03: Formal Appeal Request3/15/2024

DVA/DOD MOA

Review Process and access the worksheets necessary for DVA/DOD MOA processes.
FileDate
DHA-GL Worksheet 41: DOD/VA MOA Inpatient-Outpatient Continued Stay Review 11/20/2019
DHA-GL Worksheet : Discharge Summary11/14/2019
DHA-GL Worksheet 07: DVA/DOD MOA Initial Referral & Authorization VAMC Richmond Only11/14/2019
How to submit Continuity of Care pre-authorization DVA/DOD MOA 8/29/2019
How to submit Initial pre-authorization DVA/DOD MOA 8/29/2019
DHA-GL Worksheet 07a: DOD/VA MOA Continued Stay for SCI-TBI-Blind Rehab8/29/2019
DHA-GL Worksheet 08: DOD/VA MOA SCI-TBI-Blind DME Request Worksheet8/29/2019
DHA-GL Worksheet 07: DVA/DOD MOA Initial Referral & Authorization for SCI-TBI-Blind Rehab8/29/2019
DHA-GL: How to Submit Discharge Summary notification8/29/2019
DHA-GL: How to Submit Request for Durable Medical Equipment Pre-Authorization8/29/2019

Privacy Act Statement

This statement serves to inform you of the purpose for collecting information required by the Defense Health Agency Great Lakes and how it will be used. AUTHORITY: 10 U.S.C. Chapter 55, Medical and Dental Care; 32 CFR 199.17, TRICARE program; and E.O. 9397 (SSN), as amended. PURPOSE: To collect information from Military Health System beneficiaries in order to determine their eligibility for coverage under the TRICARE Program. ROUTINE USES: Use and disclosure of your records outside of DOD may occur in accordance with 5 U.S.C. 522a (b) of the Privacy Act of 1974, as amended, which incorporates the DOD Blanket Routine Uses published at: http://dpclo.defense.gov/privacy/SORNs/blanket_routine_uses.html. Any protected health information in your records may be used and disclosed generally as permitted by the HIPPA Privacy Rule (45 CFR Parts 160 and 164), as implemented within DOD by 6025.18-R. Permitted uses and discloses of PHI include, but are not limited to, treatment, payment, and healthcare operations. DISCLOSURE: Voluntary; however, failure to provide information may result in the denial of coverage.