ALERT! EDI Submitters - Prevent your TRICARE claims from rejecting with the Invalid Member ID (H65) edit.
HIPAA 5010- All HIPAA-covered entities must be fully compliant with all of the upgraded transaction standards for ASC X12 Version 5010 by July 1, 2012. After July 1, 2012, all transactions that fail to meet the standards of version 5010 will not be accepted and will reject back to the submitter.
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?
- Submit no more than 150 claims a month? XPressClaim is your best option. You can enter your claims right on the Internet, and it's fast and free!
- High volume of TRICARE patients? Submit claims to other payers as well as TRICARE? Here's a list of approved vendors/clearinghouses.
- Can you create an ANSI electronic file and upload via asynchronous telecommunications? Batch processing is available through our EDI Gateway mailbox system. View the Gateway user manual to see if this option is right for you. Download the Electronic Data Interchange (EDI) forms.
Have you filed an Electronic Data 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.
PGBA Payer IDs for TRICARE
Please contact your clearinghouse or vendor to make sure they are using the correct Payer ID for the TRICARE regions listed below. They may have a proprietary ID for you to use prior to submitting the claims to PGBA.
North Region Payer ID: 57106
South Region Payer ID: 61125
West Region Payer ID: 99726
Note: If your clearinghouse is Change Healthcare (formerly Emdeon), the West Region payer ID is SCWI0 for professional claims; 12C01 for institutional claims. Please call your Change Healthcare representative if you have questions (1-877-469-3263).
If region is unknown, default to payer ID below:
PGBA's TRICARE Payer ID: 38520
Electronic Data Interchange (EDI) Billing Tips
Find information and tips to help with your EDI billing.
276/277 Health Care Claim Status Request and Response
270/271 Health Care Eligibility Benefit Inquiry and Response
835 Health Care Claim Payment Advice
837 Health Care Claim Institutional
837 Health Care Claim Professional
Didn't find the answer you need?
Call the TRICARE EDI Help Desk for the South Region at 1-800-325-5920, option 2. You may also send an email to EDI.TRICARE@pgba.com.
Go 100% electronic with:
Electronic Funds Transfer (EFT)
Electronic Remittance Advice (ERA). Find information about the Remit Easy Print software.