Revenue Codes/HCPCS: Most revenue codes are now required to be billed with a valid HCPCS code, effective immediately.
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.
Applied Behavior Analysis (ABA): Learn the latest TRICARE coverage for ABA Services.
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 January 2015 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.