With the National Provider Identifier (NPI) compliance date nearly two years behind us, we at Humana
Military Healthcare Services, Inc. (Humana Military) hope that your experience has been positive and that incorporating your NPI into claims has made the submission process more efficient.
 
As you know, using your NPI is mandated by the Health Insurance Portability and Accountability Act of 1996 (HIPAA) for providers who conduct standard electronic transactions. Following the compliance date, TRICARE invoked a 12-month contingency period that allowed you to submit claims using a legacy provider identifier, NPI or both. However, that time has also passed.
 
Therefore, if you have not taken steps to comply with the HIPAA NPI rule, there is no better time to do so than now. Failure to comply with this regulation will result in TRICARE denying your claim.
 
If you are not already using an NPI, you must:

• Apply online for an NPI from the National Plan and Provider Enumeration System (NPPES) or obtain a copy of the paper application. For more information, visit the National Plan and Provider Enumeration System (NPPES) web site.
• Share your NPI(s) (both individual and corporate) with your payers, your area’s inpatient/outpatient facilities, and pharmacies and physicians with whom you interact
  regularly.
• Use your NPI(s) in all standard electronic transactions, especially if you are a TRICARE network provider required to file your claims electronically.

For registration instructions and answers to frequently asked NPI questions, log on to MyHMHS for Providers. To ensure that you use your NPI(s) correctly in all standard electronic transactions, your staff members and your practice management system and/or clearinghouse must work together and understand what is required to process your claims.
 
When you are submitting claims using NPI(s), remember that both the billing and rendering providers’ NPIs are required, when applicable. You are also encouraged to share your NPI with providers to whom you make and receive referrals. If you are filing a claim for a patient who has been referred to you for care, the NPI of the referring physician must also be included on your transactions.
 
PGBA, LLC (PGBA) is Humana Military’s claims processing partner. If you need help filing your claims
electronically, refer to PGBA’s XPressClaim^TM service. This service is HIPAA-compliant and free, and payment results are returned instantly. To begin using XPressClaim^TM for your electronic transactions, log on to PGBA’s Web site at www.myTRICARE.com today or call PBGA at 1-800-325-5920 and select menu option 2.

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