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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 for processing non-overseas 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 Prime, TRICARE Prime Remote, TRICARE Prime Remote for Active Duty Family Members, and TRICARE Standard, TRICARE Extra, and TRICARE Reserve Select (TRS) claims, CHCBP claims are filed to a different address within PGBA. Filing claims correctly ensures that your claims are paid in a timely and accurate manner.
File CHCBP claims electronically at PGBA's Web site. File all paper claims at one of the addresses listed in Figure 8.6.
Figure 8.6 CHCBP Claims Address
CHCBP Adjunctive Dental Claims
P.O. Box 7037
Camden, SC 29020-7037 |
CHCBP Behavioral Health Claims
P.O. Box 7034
Camden, SC 29020-7034 |
All other CHCBP Claims
P.O. Box 7031
Camden, SC 29020-7031 |
Claims for the Extended Care Health Option
All claims for the TRICARE Extended Care Health Option (ECHO) must have a valid written authorization.
All claims for ECHO-authorized care (including ECHO Home Health Care) that have been authorized under the ECHO program should 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 should reflect the service, not the applicable ECHO benefit limits. Pricing of ECHO services and items is determined in accordance with the TRICARE Reimbursement Manual.
Note (for beneficiary-filed claims): If a beneficiary submits a claim for the use of a privately owned vehicle, the reimbursement rate is limited to the federal government employee mileage reimbursement rate in effect on the date the transporation is provided, regardless of the number of ECHO family members being transported.
Refer to Chapter 9, Sections 4.1, 11.1, 14.1, and 18.1 of the TRICARE Policy Manual for additional claims information.
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 the address below:
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.
Claims for TRICARE Reserve Select
The applicable cost-shares, deductibles, and catastrophic caps for ADFMs using TRICARE Standard and TRICARE Extra should be followed for all individuals covered under (TRS).
TRICARE Network Providers
- Claims must be filed electronically with PGBA on behalf of TRS members in the same manner as other TRICARE claims.
- Claims may be submitted through the MyHMHS for Providers portal and 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.
Non-Network TRICARE-Authorized Providers
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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 claims.
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Non-network providers are encouraged to submit their TRICARE claims electronically.
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The cost-share for all TRS-covered members is 20 percent of the TRICARE-allowable charge for covered services from non-network TRICARE-authorized providers. TRICARE will reimburse the remainder of the TRICARE-allowable charge.
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If a non-network provider does not participate on a particular claim, members will file their own claims with TRICARE for reimbursement and then pay the non-network provider.
Note (for non-network providers): If a non-network provider does not participate on a particular claim, the provider may not charge TRS members more than 15 percent above the TRICARE-allowable charge by federal law.
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