TriCare Verify Insurance

Mana Recovery is contracted with Tri-Care insurance – we look forward to providing you the services you need.

Instructions for Completing this Form:
In order to verify benefits with Tri-care as quickly as possible we ask that you complete this form fully. Please note that you can also email insurancecards@manarecovery.com with the required ID's if you find that easier, but we cannot verify the benefits until a photo of the cards has been uploaded.
Full Name Of Person Needing Treatment*
First Last
Date of Birth*
MM slash DD slash YYYY
Social Security Number
Primary Issue / Substance(s) for Treatment
Military ID - FRONT and BACK
Drop files here or

Max. file size: 50 MB.
Tri-Care Insurance Card - FRONT and BACK
Drop files here or

Max. file size: 50 MB.
SPONSOR of Person Needing Treatment*
First Last
Date of Birth*
MM slash DD slash YYYY
Social Security Number
Military ID - FRONT and BACK
Drop files here or

Max. file size: 50 MB.
Tri-Care Insurance Card - FRONT and BACK
Drop files here or

Max. file size: 50 MB.
Phone Number For Primary Point of Contact*
Your Email*
Additional information
SMS Consent
- By checking this box you provide consent for Mana Recovery to call you. We will never share your information - see our privacy policy for more information.
- By checking this box you provide consent to receive account notification / information SMS from CTM 2 to 4 times/month. Standard data and message rates apply. Reply HELP for help, reply STOP to opt out anytime. Consent is not a condition of participation.
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Instructions for Completing this Form: