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) - XPressClaim requires the sponsor’s SSN when submitting claims. Please do not use the DBN until further notice. Learn more about the DoD Benefit Number (DBN) versus Social Security Number (SSN).

Check out the home infusion therapy billing guidelines.

See the latest information on the enhanced access to Autism Services Demonstration.

Learn more about TRICARE® and national healthcare reform.

National Defense Authorization Act: As of September 1, 2009, TRICARE non-PRIME beneficiaries (who are not eligible for Medicare) out-of-pocket copayments are waived for the following clinical preventive services: immunizations, well-child visits, colorectal, breast, cervical and prostate cancer screenings.

National Provider Identifiers (NPI): NPIs required on all electronic transactions as of May 23, 08. Read more...

Non-Network Providers:   If submitting paperclaims, TRICARE Policy now requires that your signature be in block FL80 of the UB04 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.