PROVIDERS

HIPAA 5010-The Health Insurance Portability and Accountability Act (HIPAA) is the federal regulation that requires the use of standard X12 transactions to report and inquire about healthcare services. The current version for electronic transactions is 4010A1. Version 5010 is replacing 4010A1 on January 1, 2012. Given the complexities of the conversion, you should prepare for the transition now. After January 1, 2012, version 4010A1 will no longer be valid. Please visit our EDI page  to see the 5010 Companion Guides or  test vendors/clearinghouses. Please contact us when you are ready to test at 1-800-325-5920 opt.2 or by e-mail:EDI.Tricare@palmettoGBA.com.

DoD Benefit Number (DBN) -  Learn more about the DoD Benefit Number (DBN) versus Social Security Number (SSN).

Payment cycle information: EFT payments are now processed five days a week. The payment cycle for providers who have elected to have either paper checks and/or paper remits is moving to once a week. Go 100% electronic and get paid faster! Sign up for EFT today.

Sanctioned Billing Services:  Important news you need to know if you use a Billing Agent. Read more...

OPPS: Find Outpatient Prospective Payment System (OPPS)  rates.

Claims with NDC numbers: Find information about packages (P) or units (U) when filing claims.

Non-Network Providers:  TRICARE Policy requires your signature in block FL80 of the UB04 paper claim form; otherwise, your claims will be returned.

Our Prime Partner

Click here to go to our Prime Contracting Partner's Web site to find other helpful tools.