NEW! TRICARE Appeal Rights: To submit a non-expedited reconsideration request to Health Net, specific instructions must be followed by the appropriate appealing party.
Autism Care Demonstration (ACD): Check out the latest update to the ACD program.
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.
Revenue Codes/HCPCs: UB-04 claims for outpatient services, must have a specific HCPC code and revenue code on each applicable service line.
Outpatient Prospective Payment System (OPPS): Centers for Medicare & Medicaid Services (CMS) implements quarterly updates to OPPS. Information related to the January 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.
Sole Community Hospitals: Important information regarding reimbursement.
Abortion Claims Coverage: 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 website to find other helpful tools.