PROVIDERS

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Welcome South Providers


Please Note: The website information and material is for Dates of Service prior to 1/1/2018. If you are looking for information for Dates of Service on or after 1/1/18, please go to the new contractor website: Humana Military for the TRICARE East Region.

 

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!  

 

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!

 

Home Infusion: Check out the home infusion therapy billing guidelines.

 

Referrals and Authorizations: To check status on a referral or authorization, 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.

 https://www.humanamilitary.com/

 


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