Other Helpful Hints
      

PGBA operates a TRICARE EDI Help Desk to assist you with any issues related to TRICARE electronic claims submissions. The telephone number is 1-800-325-5920, menu option 2. When you call, identify yourself as a TRICARE provider.
       

TRICARE claims that require hard-copy supporting documentation can still be filed electronically. PGBA has a dedicated fax to receive supporting documentation for electronically submitted claims. Use the EDI Support Documentation form to ensure that the documentation is correctly matched up to your claim. Download the EDI Support Documentation form with the fax number or call the TRICARE EDI Help Desk at 1-800-325-5920, menu option 2.
        

When filing claims that have OHI, avoid having to send a hard-copy EOB from the primary payer by transmitting the required information electronically. PGBA needs to know the amount the primary insurance paid. If the primary insurance is a preferred provider organization, health maintenance organization, Medicare, or other insurance where there is a limited liability for the patient, then you also must indicate the OHI-allowed amount. The OHI-allowed amount represents the amount paid by the primary insurer, plus any out-of-pocket expenses owed by the patient. In cases where the primary insurance paid zero, include the reason nothing was paid.
   

To ensure that your electronic TRICARE claims are accepted by PGBA’s system for processing, it is imperative that you reconcile your EMC transmissions with the EMC response reports returned by PGBA for every transmission. These responses show the claims that were rejected as well as the claims that were accepted for processing. Review these responses to ensure that EMC transmissions are not lost and to identify rejected claims so you can correct and resubmit them electronically for processing. If your TRICARE claims are submitted through a clearinghouse or other vendor, the PGBA responses are returned to that entity. Many clearinghouses perform their own edits and create their own reports that show how many claims were received from the provider and forwarded on to the payer, but only the PGBA responses show you which claims were received and accepted by PGBA for processing. If you are not sure if you are receiving these PGBA EMC responses, contact your vendor or PGBA's TRICARE EDI Help Desk at 1-800-325-5920, menu option 2.
     

For a listing of common EMC rejection reasons and solutions, visit Electronic Media Claims Resources.
          

To check the status of your claims, visit MyHMHS for Providers. You may also call the PGBA interactive voice response system at 1-800-403-3950. The line is available 24 hours a day, seven days a week. To check on the status of a claim in writing or to resubmit a claim, direct your correspondence to:

If you receive a duplicate payment or overpayment for a claim for TRICARE beneficiaries, Humana Military requests that this payment be returned to PGBA’s TRICARE Finance department. Please include a copy of the remittance advice and a cover letter explaining exactly why the payment is being returned. Duplicate payments for TFL claims should be returned to WPS/TFL.

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:

Return TFL duplicate payments or overpayments to:

If you do not return the overpayment, then PGBA may, after written notice, offset the amount of double payment against future claim payments.