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PCM Central Offers Unique Tools for Primary Care Managers (Article 13) |
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Wouldn’t it be nice if there were one online repository of information and resources that you could reference as you perform your duties as a TRICARE primary care manager (PCM)?
Now there is. Humana Military has created “PCM Central” to provide you and your staff members with the tools you need to manage TRICARE Prime beneficiaries’ care effectively.
PCM Central is easy to access. From the home page, click on “PCM Central” under “Provider Resources.” Once there, you will find PCM tools that are not available anywhere else on the site.
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To access most of these tools, however, you need to establish an online services account. If you haven't already done so, you can register for an account by clicking the “Sign Up” link on the right-hand side of the page. Once registered, you or your staff members can do the following through PCM Central:
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- Check on the status of a referral, authorization or claim.
- Enter a new referral or authorization.
- Check a patient’s eligibility.
- Check fee schedules.
- Look up diagnosis or procedure codes.
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Two other important PCM Central features include “My TRICARE Patient List” and “Review Your Provider Locator Information.”
By clicking the My TRICARE Patient List link, you can view a list of your patients and even see all current patient claims.
It is important for providers to keep their demographic information current. So please take a moment to visit the Review Your Provider Locator Information section and update your demographic information (if necessary).
You’ll also find the latest headlines, local provider seminar schedules, a link to the TRICARE Provider Handbook and more. For a guide on what else PCM Central offers, click the Site Demo link on the right-hand side of the page.
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Humana Military and PGBA Offer Claims Processing Resources (Article 14) |
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Humana Military and PGBA want to help all TRICARE providers have a better understanding of claims processing procedures. To reach that goal, we’ve developed the following resources: |
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Web Sites
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You can obtain the latest information about claims processing, check the status of claims and more, in the Online Provider Services section. Registered users of either the Online Provider Services section or the PGBA Web site can also submit claims electronically.
Since TRICARE network providers are required to submit claims electronically, they get paid faster and have less paper work. Humana Military encourages all providers to take advantage of the benefits of this online claims submission tool.
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IVR System
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When calling is more convenient, you can use Humana Military’s interactive voice response (IVR) system by calling 1-800-444-5445, or you can call PGBA at 1-800-403-3950 and speak to a provider representative to check on the status of claims, confirm the eligibility of a beneficiary, get an explanation of benefits and obtain pricing. |
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Remit Forms |
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Another way to ensure a smooth claims processing experience is to review all provider remits closely. The remit form is now easier to read, and it explains how to get a claim reconsidered satisfactorily. |
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ClaimCheck |
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During claims processing, PGBA uses the ClaimCheck® system to review claims and ClaimReview®, an automated module in ClaimCheck®, to check for inconsistencies with TRICARE-covered services. For example, the system will compare the procedure code with the diagnosis code. If the codes are inappropriate for each other, the claim will be denied and the remit will say, “Diagnosis Code and Procedure Code combination non-specific or unrelated.” To avoid such denials and improve claims submission accuracy, your staff should review the Claims Processing and Billing chapter of the TRICARE Provider Handbook. |
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Last Reviewed: February 13, 2007
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