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Provider Handbook
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HIPAA Transaction Standards and Code Sets
Filing Paper Claims
Checking the Status of Your Claims
Tracer Claims |
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HIPAA Transaction Standards and Code Sets |
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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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TRICARE contractors and other health care payers are prohibited from accepting or issuing transactions that do not meet the standards. In order to avoid cash flow disruptions, it is imperative that you use the HIPAA-compliant claims formats.
If you need any assistance with HIPAA standard formats for TRICARE, you may call the PGBA EMC Help Desk.
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Filing Paper Claims |
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When filing a paper claim, make sure that you complete the CMS-1500 or UB-04 accurately and fully. Submit the paper claims to:
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TRICARE South Region
Claims Department
P.O. Box 7031
Camden, SC 29020-7031
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The most appropriate [Physician’s] Current Procedural Terminology (CPT) code must be used when billing TRICARE—do not unbundle charges into separate CPT codes when a single code is more appropriate. If the CPT code(s) you are billing does not match the services authorized, the claim will be denied. Institutional providers billing with certain revenue codes require submission of Level II Healthcare Common Procedure Coding System (HCPCS) codes for description of services and supplies.
The signature of the provider, or an acceptable facsimile, is required on all participating claims. In lieu of the provider’s actual signature, a facsimile signature or signature of a representative will be accepted if TRICARE has the proper authorization forms on file. Claims submitted without the proper signature will be returned or denied. To ensure TRICARE has the appropriate signature authorization forms on file, refer to the TRICARE Operations Manual, Chapter 8.
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Checking the Status of Your Claims |
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To check the status of your claims, visit “Online Provider Services” under the Provider Resources section. You may also call the PGBA voice response system at 1-800-403-3950. The line is available 24 hours a day, seven days a week. To check on the status of a claim in writing or to resubmit a claim, direct your correspondence to:
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TRICARE South Region
Customer Service Dept.
P.O. Box 7032
Camden, SC 29020-7032
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Tracer Claims |
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When resubmitting an unchanged claim, write “Tracer” across the top of the claim form. |
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