Claims for the Continued Health Care Benefit Program
Humana Military is the contractor for the Continued Health Care Benefit Program (CHCBP) and has partnered with PGBA to process all CHCBP claims. CHCBP beneficiaries may request that providers file medical claims on their behalf. For questions and assistance regarding CHCBP claims, call PGBA at 1-800-403-3950.
While PGBA is the South Region claims processor for TRICARE programs, CHCBP claims are filed to a different address within PGBA. Filing claims correctly ensures timely and accurate claims payment.
File CHCBP claims electronically at PGBA's Web site. File all paper claims at one of the addresses listed in Figure 8.8. Figure 8.8 CHCBP Claims Address
CHCBP Behavioral Health Claims
P.O. Box 7037
Camden, SC 29020-7037 |
All other CHCBP Claims
P.O. Box 7031
Camden, SC 29020-7031 |
Claims for the Extended Care Health Option
All claims for the ECHO and the DoD Enhanced Access to Autism Services Demonstration must have a valid written authorization and the beneficiary must show as enrolled in the ECHO in DEERS.
All claims for ECHO-authorized care (including ECHO Home Health Care and the Enhanced Access to Autism Services Demonstration) that have been authorized under the ECHO program must be billed on individual line items. Unauthorized ECHO care claims will be denied.
ECHO claims will be reimbursed for the amount authorized (indicated on the written authorization provided by Humana Military) or the monthly or fiscal year benefit limit, whichever is lower. Each line item on an ECHO claim needs to correspond to a line item on the service authorization, or the claim may be denied or delayed due to research and reconciliation.
The “billed amount” for procedures must reflect the service, not the applicable ECHO benefit limits. Pricing of ECHO services and items is determined in accordance with the TRICARE Reimbursement Manual.
Refer to Chapter 9, Sections 4.1, 11.1, 14.1, and 18.1 of the TRICARE Policy Manual for additional claims information. Claims for the TRICARE Reserve Select and TRICARE Retired Reserve
All individuals covered under TRICARE Reserve Select (TRS) should follow the applicable costshares, deductibles, and catastrophic caps for TRICARE Standard- and TRICARE Extra covered ADFMs.
All individuals covered under TRICARE Retired Reserve (TRR) should follow the applicable costshares, deductibles, and catastrophic caps for TRICARE Standard- and TRICARE Extra covered retirees and their eligible family members.
TRICARE Network Providers
- File claims with PGBA electronically on behalf of TRS and TRR members just as you would file other TRICARE claims.
- Submit claims through the MyHMHS for Providers portal or the PGBA web site.
- The cost-share for all TRS members, including National Guard and Reserve members, is 15 percent of the negotiated fee for covered services from TRICARE network providers. TRICARE will reimburse the remaining amount of the negotiated fee.
- The cost-share for all TRR members, including National Guard and Reserve members, is 20 percent of the negotiated fee for covered services from TRICARE network providers. TRICARE will reimburse the remaining amount of the negotiated fee.
Non-Network TRICARE-Authorized Providers
- Participation with TRICARE (e.g., accepting assignment, filing claims, and accepting the TRICARE-allowable charge as payment in full) is encouraged, but not required, on TRS and TRR claims.
- Non-network providers are encouraged to submit their TRICARE claims electronically.
- The cost-share for all TRS-covered members is 20 percent of the TRICARE-allowable charge for covered services from participating, non-network TRICARE-authorized providers. TRICARE will reimburse the remainder of the TRICARE-allowable charge.
- The cost-share for all TRR-covered members is 25 percent of the TRICARE-allowable charge for covered services from participating, non-network TRICARE-authorized providers.
- Members will file their own reimbursement claims with TRICARE and then pay the non-network provider, if a non-network provider does not participate on a particular claim.
Note (for non-network providers): By federal law, if a non-network provider does not participate on a particular claim, the provider may not charge TRS/TRR members more than 15 percent above the TRICARE-allowable charge.
The TRICARE-allowable charge schedules can be found at the TRICARE CMAC web site. Supplemental Health Care Program Claims
Claims for the Supplemental Health Care Program (SHCP) are processed and paid through PGBA.
All TRICARE claims must be sent to: TRICARE South Region Claims Department
P.O. Box 7031
Camden, SC 29020-7031
The same balance billing limitations applicable to TRICARE apply to the SHCP. For more information regarding balance billing, see the Important Provider Information section. Back to Top |
