NEW! Annual Pricing Updates: The following claim types are subject to the latest rate updates beginning with discharge dates of service on and after October 1, 2017: DRG, RTC, PHP and Inpatient Mental Health. These claims will be held temporarily until pricing updates are received from DHA. We expect the affected facility claims to be released by mid-November. We apologize for any inconvenience and thank you for your patience.
Are you ready? Learn about the upcoming changes to the TRICARE Program beginning January 1, 2018.
Reserve Component: Reserve Component Beneficiaries are entitled to TRICARE coverage while performing military duties or for medical conditions resulting from military service. If a patient record indicates this may be the case, please file your claim with TRICARE.
PGBA is a Certified Center of Excellence, awarded by BenchmarkPortal!
Applied Behavior Analysis (ABA): BLS Certification enforced for ABA Providers.
Urgent Care Clinics: Eligible TRICARE Prime beneficiaries can obtain urgent care twice per fiscal year from an authorized provider without a referral under the Urgent Care Pilot Program.
Outpatient Prospective Payment System (OPPS): Centers for Medicare & Medicaid Services (CMS) implements quarterly updates to OPPS. Information related to the October 2017 update is available directly from CMS. Please note: Medicare specific coding requirements must be followed (with the exception of DHA developed APCs) in order to receive TRICARE reimbursement under the OPPS.
Sole Community Hospitals: Important information regarding reimbursement.
XPressClaim: Remember that providers can submit corrected claims through XPressClaim too!
Payment cycle information: EFT payments are processed five days a week. The payment cycle for providers who elect to have either paper checks and/or paper remits is once a week. Go 100% electronic and get paid faster! Sign up for EFT today.
Home Infusion: Check out the home infusion therapy billing guidelines.
Referrals and Authorizations: For all referral and authorization needs (build a referral/auth, check status or update existing referral/auths), go to Humana Military or use the IVR line at 1-800-444-5445 and listen for the prompts.
Our Prime Partner
Click here to go to our Prime Contracting Partner's website to find other helpful tools.