NEW! Annual Pricing Updates: The following claim types are subject to the latest rate updates beginning with discharge dates of service on and after October 1, 2017: DRG, OPPS, RTC, PHP and Inpatient Mental Health. These claims will be held temporarily until pricing updates are received from DHA. We expect the affected facility claims to be released by mid-November. We apologize for any inconvenience and thank you for your patience.
NEW! Delayed Payment Cycle: The last non-underwritten and underwritten cycles for fiscal year 2017 will occur on Monday, September 25. The next cycle for both will occur on Monday, October 2. During this time frame, payments will be delayed. We apologize for the inconvenience and thank you for your patience.
Are you ready? Learn about the upcoming changes to the TRICARE Program beginning January 1, 2018.
Reserve Component: Reserve Component Beneficiaries are entitled to TRICARE coverage while performing military duties or for medical conditions resulting from military service. If a patient record indicates this may be the case, please file your claim with TRICARE.
PGBA is a Certified Center of Excellence, awarded by BenchmarkPortal!
Applied Behavior Analysis (ABA): BLS Certification enforced for ABA Providers.
Urgent Care Clinics: Eligible TRICARE Prime beneficiaries can obtain urgent care twice per fiscal year from an authorized provider without a referral under the Urgent Care Pilot Program.
Outpatient Prospective Payment System (OPPS): Centers for Medicare & Medicaid Services (CMS) implements quarterly updates to OPPS. Information related to the October 2017 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.
XPressClaim: Remember that providers can submit corrected claims through XPressClaim too!
Payment cycle information: EFT payments are processed five days a week. The payment cycle for providers who elect to have either paper checks and/or paper remits is once a week. Go 100% electronic and get paid faster! Sign up for EFT today.
Home Infusion: Check out the home infusion therapy billing guidelines.
Referrals and Authorizations: For all referral and authorization needs (build a referral/auth, check status or update existing referral/auths), go to Humana Military or use the IVR line at 1-800-444-5445 and listen for the prompts.
Our Prime Partner
Click here to go to our Prime Contracting Partner's website to find other helpful tools.