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Welcome North Region Providers

NEW! Health Net and PGBA are proud to announce that once again our call center operations have been certified as a Center of Excellence by BenchmarkPortal. Read about it here.


NEW! Applied Behavior Analysis (ABA): Learn the latest changes in TRICARE coverage for ABA Services.


Air Ambulance Claims: DHA adopted the Medicare Ambulance Fee Schedule, but is reevaluating air ambulance service fees.  Until DHA provides direction, air ambulance claims will be held.  We apologize for the inconvenience & thank you for your patience.


Revised Professional Claim Form: Beginning April 1, 2014, only professional claims submitted on the Form 1500 (02/12) will be accepted.


Outpatient Prospective Payment System (OPPS): Centers for Medicare & Medicaid Services (CMS) implements quarterly updates to OPPS. Information related to the April 2014 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.


Ambulance Fee Schedule: Effective October 1, 2013 TRICARE will reimburse ambulance claims using Medicare's Ambulance Fee Schedule (AFS). New billing guidelines can be located in the TRICARE Reimbursement Manual.


Abortion Claims Coverage: New details about submitting abortion claims.


XPressClaim: Remember that you can submit corrected claims through XPressClaim too!


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 Web site to find other helpful tools.

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