Published on June 12, 2013
in Clearinghouse - ACTION REQ.
The clearinghouse would like to remind providers of the dates below regarding the TRICARE West conversion to PGBA which took place on April 1, 2013:
• 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. Please submit claims with dates of service on or before March 31, 2013 no later than July 29, 2013.
• Claims with dates of service on or after April 1, 2013, must use 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.
Action Required: Providers should be aware of these dates and take necessary actions.
If you have any questions, please contact Client Services at 1-888-348-8457, option 2.