NEW! Autism Care Demonstration (ACD): Check out the latest update to the ACD program.
TRICARE Appeal Rights: To submit a non-expedited reconsideration request to Health Net, specific instructions must be followed by the appropriate appealing party.
Breast Pump Policy Update: TRICARE policy has been updated to include the coverage of breast pumps and supplies and breastfeeding counseling, effective July 1, 2015.
Health Net and PGBA are proud to announce that for the third consecutive year our call center operations have been certified as a Center of Excellence by BenchmarkPortal. Read about it here.
Outpatient Prospective Payment System (OPPS): Centers for Medicare & Medicaid Services (CMS) implements quarterly updates to OPPS. Information related to the April 2016 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.
EDI Submitters - Prevent your TRICARE claims from rejecting with the Invalid Member ID (H65) edit.
Our Prime Partner
Click here to go to our Prime Contracting Partner's website to find other helpful tools.