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When you have a claims question, it’s helpful to know which customer service number to call first to get the answers you need.
For questions regarding claims status, eligibility, other health insurance, third-party liability, and explanation of benefits, your best option is to start by calling the South Region claims processor, PGBA, LLC (PGBA). PGBA has an Automated Response Unit that can handle many of your questions effectively and efficiently. Customer service associates are also available to assist you with your claims questions.
If you have a claims issue involving Medicare, you should call Wisconsin Physicians Service (WPS), the claims processor for all claims dealing with both Medicare and TRICARE.
For behavioral health claims questions relating to authorization issues, your best option is to start by calling ValueOptions, Humana Military’s behavioral health subcontractor for the TRICARE South Region. If the question is more complicated and cannot be resolved during that initial call, it will be forwarded to a claims specialist who will research the issue and return your call within two business days.
Any claims question that involves authorization issues for medical or surgical services, including physical therapy, speech therapy and occupational therapy, should be directed to Humana Military.
Knowing who to contact first when you have a claims question can help ensure you receive quality customer service and a timely resolution to your claims issues without a lot of delay and difficulty.
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