1. Can I see TRICARE patients in my office? Do I have to be certified?
   If you have submitted any claims to the TRICARE South Region claims processor, PGBA, LLC (PGBA) for a TRICARE patient and received payment, you likely are a certifi ed provider for TRICARE and can see patients in your offi ce as a non-network provider. If you have been “networked” by Humana Military Healthcare Services, Inc. (Humana Military) or ValueOptions, Inc. (ValueOptions), you are a contracted provider and preferred for TRICARE Prime beneficiaries who are directed to civilian providers for primary and/or specialty care.
   
    
2. Is there a TRICARE fee schedule?
   TRICARE has reimbursement/fee schedules for all health care components. TRICARE’s fee  schedule is most commonly referred to as the CHAMPUS maximum allowable charge and in almost all instances, will mirror Medicare reimbursement. TRICARE provider reimbursement information is available online at www.tricare.mil.
    
   
3. How do I check on referrals and prior authorizations for my TRICARE patients?
   Providers who are registered users of the secured services available on MyHMHS for Providers can check the status of current referrals and prior authorizations for your office. Primary care managers have access to all TRICARE patient referrals for the benefi ciaries assigned to their panel. Confi rmation can be printed from the Web site if you need it for a patient’s chart. Humana Military also provides you with current prescription data for the patient.
    
   
4. Am I required to file claims for TRICARE electronically?
   TRICARE requires that claims be filed electronically. If you are a TRICARE network provider, you have agreed in your contract to comply 100 percent with electronic media claims (EMCs) submissions to PGBA for TRICARE claims. Humana Military also offers innovative solutions and options to make filing TRICARE EMCs easier. Visit the PGBA and Humana Military Web sites at www.myTRICARE.com.
    
   If you are a non-network provider and mailing paper claims to PGBA, there may be delays in processing.
    
   
5. What are the best options for filing TRICARE claims electronically?
   PGBA has an electronic claims entry option at www.myTRICARE.com that is free and very efficient. Known as XPressClaim™, the service requires one claim entry at a time, but it offers proof of eligibility and a complete breakdown of the allowed charges and any out-of-pocket charges from the patient before you evensubmit. Turnaround time for processing is less than five
   days. All you have to do is sign up for the secured services.
    
   An electronic batch claim process called eZ TRICARE Claims is also available free of charge to all network providers.
    
   If you already have a clearinghouse or billing service, you may want to check to see if they are filing TRICARE claims electronically for you. If you or your clearinghouse needs assistance with electronic claims filing for TRICARE, please contact PGBA at 1-800-403-3950 and ask for the EMC Help Desk.
    
   
6. Do I have a Provider Representative?
   TRICARE network providers in the TRICARE South Region have a provider representative at Humana Military. They provide answers to your questions concerning your contracts and such issues as balance billing, non-covered services, claims and much more. If you do not know who the TRICARE provider representative is for your area, please call the Humana Military Interactive Voice Response Line at 1-800-444-5445. You will be asked to key your tax identification number/employer identifi cation number to confirm that you are a network provider, and you
   will then be forwarded to your provider representative’s phone line. If you are a network behavioral health care provider, please contact ValueOptions at 1-800-700-8646.
   

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