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 4010A1 version for electronic transactions will be replaced with version 5010. Given the complexities of the conversion, you should prepare for the transition now. The deadline for converting to the new format is still outstanding. 5010 Companion Guides can be found below. Here's a list of HIPAA 5010 approved vendors/clearinghouses. Check out the list of trading partners that we are currently working with to test HIPAA 5010. If your facility, billing service, vendor or clearinghouse is not on the list, have them contact the EDI department at 1-800-325-5920 opt. 2 or by e-mail: EDI.Tricare@palmettoGBA.com.
TRICARE® network providers must file 100% of their TRICARE claims electronically. We encourage non-network providers to take advantage of this feature as well. Electronic claims are faster than paper claims, so you get paid faster. Electronic filing also saves you time and money.
Which electronic claims option is right for you?
Have you filed an Electronic Date Interchange (EDI) provider Trading Partner Agreement with us?
Download a copy of the HIPAA EDI Provider Agreement.
Download the Clearinghouse/Direct Submitter Trading Partner agreement.
Please note the EDI Vendor/Clearinghouse Disclaimer.
If your clearinghouse is Emdeon (formerly WEBmd), please verify that your software application has the correct Payer ID. The North Region Payer ID is 57106. The South Region Payer ID is 61125. Please call your Emdeon representative if you have questions (1-877-469-3263). PGBA's published Payer ID for TRICARE claims is 38520. Please contact your clearinghouses or vendors to find out if they are using a different Payer ID for PGBA.
Health Insurance Portability and Accountability Act (HIPAA) Companion Guides
To view or print, you will need the Adobe Acrobat Reader.
HIPAA EDI Provider Agreement
276/277 Healthcare Claim Status (V4010)
270/271 Healthcare Eligibility (V4010)
276/277 Healthcare Claim Status (V5010)
270/271 Healthcare Eligibility (V5010)
835 Healthcare Claim Payment/Advice (V4010) (Find information about the free Remit Easy Print software for 835 Healthcare Claim Payment/Advice).
835 Healthcare Claim Payment/Advice (V5010)
837 Institutional Healthcare Claim (V4010)
837 Professional Healthcare Claim (V4010)
837 Institutional Healthcare Claim (V5010)
837 Professional Healthcare Claim (V5010)
Electronic Data Interchange (EDI) Billing Tips
Find information & tips to help with your EDI billing.
Didn't find the answer you need?
Call the TRICARE EDI Help Desk for South Region at 1-800-325-5920, option 2. You may also send an e-mail to edi.tricare@pgba.com.
Go 100% electronic with:
Electronic Funds Transfer (EFT)
XPressClaim ®
Electronic Remittance Advice (ERA) (Find information about the Remit Easy Print software)