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Claims Overview

TRICARE network providers must file their patients’ TRICARE claims, even when the patient has Other Health Insurance (OHI). PGBA, LLC is Humana Military’s partner for claims processing in the TRICARE South Region. Visit Leaving Site for more information about claims processing requirements.

TRICARE requires providers to file claims electronically. Payments made to network providers for medical services rendered will not exceed 100 percent of the TRICARE allowable charge.

National Provider Identifier (NPI)

The NPI is a 10-digit number used to identify providers in standard electronic transactions. It is a requirement of the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

The NPI simplifies the health care administration and enables efficient electronic transmission of health information. Providers must submit the appropriate NPI on all HIPAA-standard electronic transactions.

Both individual providers (Type 1) and organizational providers (Type 2) should register all NPIs with Humana Military. The easiest way to do this is via the secure Self-Service for Providers.

To learn more, review claims information, including information about HIPAA,  in the TRICARE Provider Handbook. Get a summary of TRICARE Claims and Billing Tips information with our handy chart.

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Last Update: September 26, 2014