A simple claim error can lead to a complicated and stressful situation for you, your staff and the TRICARE beneficiary involved. Such situations are further complicated when debt collection agencies become involved. When a claims problem occurs, you’ll often see quicker results if you work directly within the TRICARE system by collaborating with your regional contractor, claims processor and beneficiary advocates.

Both network and non-network providers are encouraged to explore every possible means to resolve claims issues without involving debt collection agencies.

In the TRICARE South Region, Humana Military Healthcare Services’ claims processor partner, PGBA, LLC (PGBA), is your first point of contact for resolving claims issues. In most instances, PGBA will be able to resolve your issue or concern. Call PGBA at 1-800-403-3950 or visit the PGBA Web site.

If the problem cannot be resolved at this level, encourage your patients to contact a TRICARE beneficiary advocate. Beneficiary counseling and assistance coordinators (BCACs) and debt collection assistance officers (DCAOs) can help the beneficiary better understand their benefit and help them understand and resolve claims issues.

DCAOs, in particular, help beneficiaries evaluate the validity of collection agency claims and/or the negative credit reports that sometimes result from them.  Sometimes, when acting as the beneficiary advocate, the DCAO may even contact you. Any information you can provide to expedite resolution is greatly appreciated.

BCACs and DCAOs are located at TRICARE Regional Offices and at military treatment facilities (MTFs). To find a BCAC or DCAO near you, call the closest MTF or search the TRICARE BCAC/DCAO Directory.