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Humana Military and PGBA Offer Four Electronic Claims Submission Options (Article 5)
  TRICARE now requires that network providers file claims electronically.

Electronic claims help network providers submit cleaner claims, receive payment faster and reduce paperwork.

On average, TRICARE electronic claims process about two to three weeks faster than paper claims. Electronic claims eliminate delivery time and postage. By submitting TRICARE
claims electronically, network and non-network providers are eligible to receive electronic remittance advice (ERA). Network providers who submit claims electronically may receive direct payments through electronic funds transfer (EFT).

Humana Military and PGBA offer a choice of four options for filing electronic claims.
XPressClaim
You can file claims online through the XPressClaim system on www.myTRICARE.com. XPressClaim is a secure, fast
way to submit CMS-1500 claims and receive instant results.

With XPressClaim, you can print a Patient Summary Receipt on the spot, while your patient is still in the office. The system will adjudicate most TRICARE claims upon submission and provide a clear explanation of what TRICARE allows and what the patient owes. It also uses encryption technology to transmit claims securely and protect confidentiality in compliance with rules under the Health Insurance Portability and Accountability Act (HIPAA).

Best of all, the service is free. There is no additional hardware or software to buy so long as you have Internet access.

To sign up for XPressClaim, go to the provider section of www.myTRICARE.com.

eZ TRICARE Claims
This option is only available for network providers. This HIPAA-compliant claims filing system uploads batches of
claims directly from your practice management system.

There’s no software to install, no data entry, and the service is free. National Standard Format (NSF), ASC X12 837
and CMS-1500 print files can be read by eZ TRICARE Claims.

Claims Clearinghouses
You can choose to submit claims via electronic claims clearinghouses. Clearinghouses allow you to submit claims to TRICARE and various other payers, which simplifies matters for your office.

Contact your current vendor to learn if any adjustments need to be made to continue submitting TRICARE claims once your area transitions to the South Region. The clearinghouse may list Humana Military as Humana Military Healthcare Services or under the name of claims processing partner PGBA.

Electronic Data Interchange (EDI) Gateway
If your systems can create HIPAA-compliant claims formats and you prefer to send your claims directly to PGBA, then PGBA’s EDI Gateway may be right for you.

PGBA built the EDI Gateway to handle all inbound and outbound HIPAA-compliant EDI transactions. The
communications protocols supported are Asynchronous Dial-up, File Transfer Protocol (FTP), and CONNECT: Direct/NDM.

Faxing Supporting Documentation
TRICARE claims that require hard copy documentation can still be filed electronically. To do this, fax documents to
PGBA using the special fax cover sheet, which you can download online.

For help in deciding which electronic claims option is best for you, call PGBA’s Electronic Media Claims Help Desk
at 1-800-325-5920. Select menu option 2, and identify yourself as a TRICARE provider.

 
Checking Claims Status
You can check claims status on Humana Military’s Web site by clicking on "Online Provider Services" in the "Provider Resources" section. You can also call PGBA at 1-800-403-3950 or write to:
           TRICARE South Region,
           Customer Service Dept.
           P.O. Box 7032
           Camden, SC 29020-7032

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