Published on March 26, 2013
in Clearinghouse - ACTION REQ.
Reminder: Due to the upcoming TRICARE West conversion to PGBA on April 1, 2013, the following actions are required:
Claims with dates of service on or before March 31, 2013, must continue to use CPID 7452 for Professional and CPID 3552 for Institutional claims (Payer ID WESTR). These will be sent to WPS.
Claims with dates of service on or after April 1, 2013, must use new CPID 6286 for Professional and CPID 5648 for Institutional claims (Payer ID 99726). These will be sent to PGBA.
Please use the TriWest Transition Claims Processing Matrix to determine how to submit claims based on dates of service and admit and discharge dates to ensure they are routed to the correct contractor. Both WPS and PGBA have processes in place to forward claims to the appropriate processor based on dates of service should they mistakenly receive claims for each other. Please note, if a claim spans dates it will be manually split and the appropriate service lines will be dropped to paper and forwarded to the correct processor. To avoid delays in claim processing and payments, please review the matrix and submit claims accordingly to the appropriate CPIDs.
PGBA will begin accepting DOD Member ID numbers containing 9, 10 or 11 alphanumeric effective April 1, 2013.
Other Subscriber Claim Filing Indicator Codes of MA, MB or OF are not allowed at this time at PGBA. The clearinghouse will reject claims that contain MA, MB or OF. PGBA plans to relax this edit as close to the conversion date as possible. The clearinghouse will remove the edit when notified by PGBA. Providers should be aware of possible rejects on or after 4/1/2013 until the edit is removed.
PO Box not allowed for Billing Provider or Service Facility.
If the Billing/Pay to Provider is a group, then the Rendering Provider is required. Providers should ensure they are sending the proper Rendering Provider Name and NPI when billing as a group to avoid claim rejections.
Action Required: Providers should be aware of these updates and take necessary actions regarding this transition.
If you have any questions, please contact Client Services at 1-888-348-8457, option 2.