Published on May 6, 2013
in Clearinghouse - ACTION REQ.
The clearinghouse would like to inform providers of potential electronic remittance crossover between TRICARE West and TRICARE North and South since the conversion from WPS to PGBA on April 1, 2013 due to the beneficiary's enrolled TRICARE Region.
CPIDs 3552 and 7452 TRICARE West (via WPS for dates of service on or before March 31, 2013)
CPIDs 6286 and 5648 TRICARE West (via PGBA for dates of service on or after April 1, 2013)
CPIDs 4456, 6594 and 8503 TRICARE North and South (via PGBA)
The beneficiary's TRICARE Region may play a role as to which Region the remittance will be returned when a provider is enrolled in electronic remittance for both TRICARE West and TRICARE North and South. For example, if the beneficiary is enrolled in the West Region but the claim is filed using a CPID for the North and South Region and the provider is enrolled for remittance in West and North and South; then the remittance will be returned to the provider using a CPID for the West Region since that is where the beneficiary is enrolled. However, if the provider is only enrolled for remittance in the North or South Region; then the remittance will be returned under North and South.
Action Required: Providers should be aware of the potential remittance cross over between West and North and South CPIDs based on the beneficiary's TRICARE Region.
If you have any questions, please contact Client Services at 1-888-348-8457, option 2.