Capital/Direct Medical Education

If I have a discrepancy in the number of TRICARE inpatient days, how do I prove to TRICARE that I am eligible for additional days?

If you want to show TRICARE that you are eligible for additional days, please check your TRICARE Summary Payment Voucher for the criteria listed below.

If the TRICARE Summary Payment Voucher meets all the criteria, please send it to:

PGBA, LLC
Attn: TRICARE Accounting, AG-790
Capital and Direct Medical Education Reimbursement
P.O. Box 100245
Columbia, SC 29202-3245

To send your request using Fedex, UPS or Airborne, use this address:

PGBA, LLC
Attn: TRICARE Accounting, AG-790
Capital and Direct Medical Education Reimbursement
Building One
2300 Springdale Drive
Camden, SC 29020

Please note: Cap/DME does not accept TRICARE for Life (TFL) or CHAMPVA claims.

  1. Provider Number - Social Security Number (SSN) or TIN of the provider who performed the services.
  2. Patient's Name - Make sure the patient is not already on our listing for the same dates of service.
  3. Discharge Date - The discharge date must fall within the fiscal year for which the provider requests reimbursement.
  4. Diagnosis Related Group (DRG) Number - Ensure that the claim is subject to DRG-based payment and has a DRG number. Psychiatric claims are identified as "mental health per diem" and do not show a DRG number.
  5. TRICARE Payment - Make sure that TRICARE has made a payment on the claim.
  6. Cost-share/Copay - If there is no TRICARE payment, but there is a cost-share/copay, the claim is eligible for reimbursement.