Published on February 18, 2013
United Healthcare Military & Veterans has awarded PGBA, LLC with a contract to process claims and provide customer service for the TRICARE - West Region beginning April 1, 2013.
- Claims with dates of service on or before March 31, 2013, must continue to use CPIDs 7452 for Professional and 3552 for Institutional claims (Payer ID WESTR) and will be sent to WPS, the outgoing TRICARE West subcontractor.
- Claims with dates of service on or after April 1, 2013, must use new CPIDs 6286 for Professional and 5648 for Institutional claims (Payer ID 99726) and will be sent to PGBA.
- Providers only need to include the CPID (not Payer ID) in the claim. The clearinghouse will manage the appropriate Payer ID changes for our customers.
- Payer agreements for electronic claims are required.
- Providers already approved to submit electronic claim transactions through the clearinghouse do not need to complete a new agreement.
- WPS will continue to accept new provider agreements for electronic claims until further notice.
- Payer agreements for electronic remittance are required.
- Providers already approved to receive remittance advice through the clearinghouse do not need to complete a new agreement.
- WPS will no longer accept new provider enrollments for ERA transactions effective 1/31/2013.
- PGBA will be accepting new provider enrollments for ERA transactions. The clearinghouse will provide additional notification when the PGBA enrollment forms for ERA are available on Collaboration Compass.
- PGBA will begin accepting DOD Member ID numbers containing 9, 10 or 11 alphanumeric effective April 1, 2013.
- As additional edit changes are identified, they will be included in future notifications.
None at this time, however, providers should be aware of the transition and watch for future notifications regarding this transition.
If you have any questions, please contact Client Services at 1-888-348-8457, option 2.