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Provider Handbook
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Claims
Processing
and
Billing
Information
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PGBA, LLC
PGBA Contact Information
Claims Processing Standards and Guidelines
Filing Electronic Claims
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South Region Claims Processor |
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PGBA, LLC |
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PGBA, LLC, (PGBA) is the Humana Military partner for claims processing in the TRICARE South Region. Visit the PGBA Web site for more information about PGBA and claims processing requirements.
TRICARE network providers must file their patient’s TRICARE claims, even when the patient has other health insurance. TRICARE requires your claims to be filed electronically. Payments made to network providers for medical services rendered will not exceed 100 percent of the TRICARE allowable charge.
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PGBA Contact Information |
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| Phone |
1-800-403-3950 |
| Fax |
1-803-713-0354 |
| Mail |
PGBA South Region Claims
Department P.O. Box 7031
Camden, SC 29020-7031 |
| E-mail |
Details on PGBA Web site |
| Web site |
PGBA Web site |
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Claims Processing Standards and Guidelines |
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TRICARE requires your claims to be filed electronically with the appropriate HIPAA compliant standard electronic claims format. If a non-network provider must submit claims on paper, TRICARE requires them to be submitted on either a CMS-1500 (professional charges) or a UB-04 (institutional charges) claim form. The following information gives you guidelines for processing claims in the South Region. |
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Filing Electronic Claims |
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There are many benefits to filing TRICARE claims electronically. These benefits include:
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- Improved cash flow—On average, TRICARE electronic claims are processed two to three weeks faster than paper claims. This, combined with the elimination of mail time, means that you will receive your TRICARE payments much faster if you file your TRICARE claims electronically.
- Reduced postage and paper-handling costs
- Elimination of data entry errors
- Better audit trail—Electronic media claims (EMC) response reports show you which claims were accepted for processing. Also, front-end EMC edits give you prompt feedback regarding problems with your claims, allowing you to correct and resubmit them more quickly.
- Real-time claims processing—If you are using XpressClaimSM on the PGBA Web site (more information below), you can submit your claims online and instantly find out how much TRICARE will pay.
- 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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