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Provider Handbook
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Corrected Claims
Timely Filing
Returning Incorrect Payments |
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Corrected Claims |
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When submitting a correction to those claims previously accepted by PGBA for processing, the claims must be flagged as corrected claims. For details about how to submit corrected claims electronically, refer to the PGBA HIPAA Companion Guides for 837 claims. If submitting a corrected claim on paper, write “Corrected” across the top of the claim form and resubmit the form. If the entire claim was previously rejected by PGBA, the claim will need to be corrected and resubmitted as a new claim. |
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Timely Filing |
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All TRICARE provider claims must be submitted to PGBA for payment within one year of the date the service was rendered or according to the provider contract. |
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Returning Incorrect Payments |
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If you receive a duplicate or overpayment for a claim for TRICARE beneficiaries, TRICARE requests that this payment be returned to TRICARE Finance. Duplicate payments for TRICARE For Life (TFL) claims should be returned to Wisconsin Physicians Service (WPS)—TRICARE For Life. Please include a copy of the remittance advice and a cover letter explaining exactly why the money is being returned. If a remittance advice is not included, please provide information about the beneficiary and the claim (including the recoupment case number) to help ensure that the refund is credited to the correct claim.
Return duplicate payments or overpayments (except TFL) to:
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PGBA
Attn: TRICARE Finance
TRICARE Refunds/AG900 PGBA
P.O. Box 100279
Columbia, SC 29202-3279
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Return TFL duplicate payments or overpayments to:
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Wisconsin Physicians Service
Attn: TDEFIC
P.O. Box 77028
Madison, WI 53707-1028
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If you do not return the overpayment, then PGBA may, after written notice, offset the amount of double payment against future claim payments. |
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