GOVERNMENT AGENTS

If you haven't already joined myTRICARE Secure for Providers, join now! Registration is free, and you'll find XPressClaim is one of many Web-based self-service options that make it easier to manage your TRICARE business.
If you're already a member of myTRICARE Secure for Providers, just Sign In and select the XPressClaim menu.
After you sign up online, we'll send you a Security Key Code. When you receive this code, go to our Web site and sign in with the username and password you chose when you signed up. Then you'll be prompted to enter your Security Key Code. This is the only time you will need to use the Security Key Code. Once you've entered the code successfully, you'll be able to sign up for XPressClaim and start using it right away.

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What are the system requirements for XPressClaim?

To run XPressClaim on your computer, you will need an Internet connection. We recommend the Internet Explorer 6 browser. XPressClaim works under Microsoft Windows 95, 98, ME, NT, 2000, or XP operating systems. XPressClaim is also compatible with the current Apple Mac operating system and Safari. Although not required, we recommend a fast Internet connection speed for best results.

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For which patients can I submit an XPressClaim?

If you submit claim forms, CMS 1500-08/05 or UB04 to PGBA for TRICARE patients, you can use XPressClaim! Please check to see if your patient is in a PGBA TRICARE claims processing region.

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How does XPressClaim work with my practice management system?

It doesn't — because you don't need it to! XPressClaim works entirely on the Internet. You enter basic claims information directly into XPressClaim using your Internet connection. XPressClaim requires very little data entry; most selections are available with the click of your mouse. That means you don't have to worry about whether your practice management system is compatible with XPressClaim!

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How is XPressClaim different from other electronic claims systems?

It's faster and it's free!

XPressClaim lets you see immediately if a patient is eligible for TRICARE coverage.
There are no transaction fees to submit a TRICARE XPressClaim. You don't have to pay an Electronic Data Interchange (EDI) company or its claims "clearinghouse" to handle your transactions.
There's no software or hardware to buy (other than using your existing office personal computer[s] and Internet connection service).
You get immediate results. The XPressClaim often completes right before your eyes with a clear explanation of the payment allowable amounts and patient payment responsibility.
When you see the message "Your XPressClaim is completed" and it shows an amount allowable to be paid to the provider, you can generally expect PGBA to cut the check and mail it to you within 2-5 days!
You can even print and give the patient a Patient Summary Receipt on the spot!
You can then quickly enter the results into your accounts receivable practice management system, which helps you settle your accounts faster!
The bottom line is your TRICARE claims are processed faster — so you get your money faster.

First, you will need to register your practice on www.myTRICARE.com and choose to accept the XPressClaim online agreement. It's quick and easy. If you have multiple locations or multiple providers, you can set up your XPressClaim file by location, by city, by provider or even by specialty.
Once you've registered with myTRICARE Secure for Providers on myTRICARE.com, we'll pre-load patient information for all your TRICARE patients from claims we've processed for you the past 12 months. The only time you'll need to enter patient information is when you have a new patient. And even then, all you need is the TRICARE sponsor's Social Security Number and the patient's date of birth.
To file claims, you'll need the dates of service, standard ICD-9 diagnosis and CPT-4 procedure codes, and any other basic data related to the diagnosis. You can submit up to 50 lines of information on one XPressClaim!

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How do I know my insurance and patient data are secure during transmission?

XPressClaim uses highly sophisticated encryption technology to transmit your claims securely. We fully protect the confidentiality of your patient records and information on the Internet.

On the average, traditional paper claims can take up to four weeks for payment. Electronic claims routed through a clearinghouse are paid more quickly, but there can be significant delays because of coding errors and a process known as "batching" claims before submitting them to payers. Also, the electronic clearinghouse often takes a day or two to submit the claim to the insurance carrier.
With XPressClaim, your claims bypass the clearinghouse and go directly into PGBA's TRICARE system, eliminating time-consuming steps and opportunities for error.
As a result, you will receive TRICARE payment much faster — within 5-15 days.

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Do I have to purchase hardware or software?

XPressClaim is totally Internet based. There is no software or hardware to buy (other than your Internet service, if you don't already have one).

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What does it cost to use XPressClaim?

Nothing. PGBA provides XPressClaim as a free service so providers who accept TRICARE assignment can submit claims via the Internet.

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How often is XPressClaim updated?

Since XPressClaim is an Internet product, there are no updates. Every time you sign in to XPressClaim, you automatically get the latest version. We're building new time-saving features into XPressClaim all the time, so you'll have instant access to all new features!

How do you control access to XPressClaim?

When you register for XPressClaim, you will choose a unique username and password. You also will receive a Security Key Code by mail. Problems with Security Key Code?

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How can I control access to XPressClaim within my practice?

It is very easy for you to control access to XPressClaim. You determine who within your practice can use XPressClaim. Then each person you designate will set up a username and password, and receive a unique Security Key Code.

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I already send claims electronically. How does XPressClaim benefit me?

XPressClaim saves you money. Not only is it a free service, you won't spend money on postage to mail claims, multiple phone calls to resolve a delayed claim or re-submissions of "tracer" claims. XPressClaim also saves time. Because XPressClaim processes in real time, you will usually be able to see immediately if you've made any errors — and you can easily correct them. The cleaner the claim, the faster it completes — and the faster you get paid.

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How often can I submit claims?

You may submit XPressClaims for legitimate TRICARE patient services rendered as often as you like. We suggest you submit the XPressClaim while the TRICARE patient is still in your office. That way, you can often collect the proper amount owed (if any) from the patient. However, you can also choose to wait until later and submit a number of XPressClaims all at one time if that is how you wish to manage your office.

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When can I submit my claims?

Because XPressClaim is a real time data exchange, you can transmit whenever you want, 24 hours a day, 7 days a week. So regardless of your time zone, whether you're working late or catching up on a weekend, all you have to do is click to submit!

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How do I know that my claims have been sent?

Within seconds after transmitting each claim, you will receive a message that tells you that the claim has been accepted for processing, if there are any errors or missing information and how the claim was processed. If a claim is more complicated and needs to be resolved by PGBA, dedicated associates at PGBA will process the claim as a priority. Most often, such claims will complete within 10 days or less!

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Does XPressClaim require special staff training?

XPressClaim requires no special training. It's easy to learn and easy to use. See for yourself by visiting the XPressClaim demo on our Web site.

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Will changing my Internet service provider affect my software?

No. Changing your Internet service provider will not have any effect on your ability to submit an XPressClaim.

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I would like to reduce coding errors on my claims. Can XPressClaim help?

Absolutely! Because XPressClaim operates in real time, you'll receive quick, easy-to- understand messages that tell you if there is problem with the claim. In most cases, you can correct the problem immediately. This eliminates days and weeks of having to "wait and see" if the claim completes. XPressClaim will also greatly reduce the number of claims you must re-submit for correct payment.

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What is an NDC number and when should I use it?

The NDC number is the National Drug Coding Number (NDC#). XPressClaim requires an NDC# when you submit a procedure code for an injection or a drug when there isn't an established TRICARE Maximum Allowable Charge. An NDC# is required for all injectable home infusion drugs.

Can I submit a UB-04 in XPressClaim?

Yes — XPressClaim accepts UB04 claim forms.

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I am having trouble entering claims in XPressClaim. What is the best way to enter claim data?

You may be having trouble if you're using the space bar to move to the next field when you're entering claim information. Putting an extra space in the field can create invalid information. Instead, use the TAB key to move to the next field and you shouldn't have any more trouble.

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Where can I put an authorization number on XPressClaim?

If the authorization number is on file with TRICARE, you do not need to enter the authorization number – XPressClaim will enter it automatically. You can also provide additional information by writing it in the comment box after you submit the claim.

How do I submit Other Health Insurance ( OHI) information in XPressClaim?

To submit OHI information on an XPressClaim, just enter the correct information into the "OHI allowed amount" and the "OHI paid" fields on the Claim line details page. Completion of the Other health insurance information page is optional. This information does not affect the way a claim processes. To opt-out of these pages and continue, just select "Submit claim."

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Can I submit an Adjunctive Dental XPressClaim?

Yes, XPressClaim does accept adjunctive dental claims.

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Can I submit multiple dates of service on one claim?

Yes, you can easily submit multiple dates of service on a Professional claim. XPressClaim defaults each line item to today's date, but you can easily change it to past dates, or even different dates for each line item.

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Can I use XPressClaim to batch claims?

XPressClaim is not a batch claim system. It is a one claim at a time product built on the assumption that provider's would/could use it while the patient is still in their office. For batch claim systems, providers should use 837 transactions.

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