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Provider Handbook
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Previous Page Table of Contents Next Page
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Electronic Claims
xPressClaim
eZ TRICARE Claims
Clearinghouses
HIPAA Transaction Standards and Code Sets |
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Billing and Claims |
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Electronic Claims |
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TRICARE requires your claims to be filed electronically. There are many benefits to filing TRICARE claims electronically, which include:
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Improved cash flow to the provider—On average, TRICARE electronic claims are processed two to three weeks faster than paper claims. This, combined with the elimination of mail time, means you will receive your TRICARE payments much faster if you file your claims electronically.
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Reduced postage and paper-handling costs
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Elimination of data entry errors
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Better audit trail—Electronic media claims (EMC) response reports are available to show you which claims were accepted for processing. Also, front-end EMC edits give you much faster feedback regarding problems with your claims, allowing you to correct and resubmit them more quickly.
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Real-time claims processing if you are using XPressClaimSM.
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Electronic remittance advice (ERA) and electronic funds transfer (EFT)—Network providers who file all of their TRICARE claims electronically are eligible to receive ERAs and EFTs.
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Humana Military offers innovative solutions that allow you to file your claims electronically, making filing TRICARE EMC easier. |
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XPressClaim |
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With XPressClaim, providers can file TRICARE claims securely and receive instant payment validation while their patients are still in the office. There is no cost to use XPressClaim. |
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eZ TRICARE Claims |
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With eZ TRICARE Claims, providers can upload batches of claims directly from their practice management systems. There is no software to install and no additional data entry for your TRICARE claims. eZ TRICARE Claims can accept a variety of claims formats, including National Standard Format (NSF) and ASC X12 837. For more information, call a ValueOptions Provider Relations Representative at 1-800-700-8646. |
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Clearinghouses |
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TRICARE claims are received from a large number of EMC clearinghouses. Contact your current vendor to find out what needs to be done to send claims to TRICARE. |
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HIPAA Transaction Standards and Code Sets |
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The Health Insurance Portability and Accountability Act (HIPAA) final rule on Transaction Standards and Code Sets mandates that all health care providers, plans, and clearinghouses use new standard formats when conducting certain transactions electronically. The HIPAA standards are in place, enabling health care providers to submit standard electronic transactions for eligibility, authorization, referrals, claims, or claims status. For your TRICARE claims, the following standard formats must be used:
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- ASC X12N 837—Health Care Claim:
Professional, Version 4010 and Addenda
- ASC X12N 837—Health Care Claim:
Institutional, Version 4010 and Addenda
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When fully implemented, TRICARE contractors and other health care payers will be prohibited from accepting or issuing transactions that do not meet the new standards. In order to avoid future cash flow disruptions, it is imperative that all providers convert to the HIPAA-compliant claims formats.
For more information on HIPAA Transactions and Code Sets, visit the PGBA Web site.
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