Published on July 11, 2013
in Clearinghouse - ACTION REQ.
Update to Notice Sent on 06/11/2013:
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 claims will continue to be sent to WPS per the existing process. 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 claims will be sent to PGBA per the new process.
•As of July 30, 2013 all TRICARE West claims regardless of dates of service must be sent to CPID 6286 for Professional and CPID 5648 for Institutional claims.
-PGBA is accepting DOD Member ID numbers containing 9, 10 or 11 alphanumeric effective April 1, 2013.
-Nine numeric Member IDs must be a valid Social Security Number (SSN)
-Ten numeric Member IDs must be a valid DOD ID number that can be cross walked to the Tricare eligibility system and a direct match found on SSN. If no match found, then payer error H65 will occur stating it must be 9 or 11 alphanumeric.
-Eleven alphanumeric Member IDs must be a valid DBN number.
Action Required: Providers should be aware of the transition details and edit changes above.
If you have any questions, please contact Client Services at 1-888-348-8457, option 2.