Published on July 25, 2013
Effective July 30, 2013, all TRICARE West claims regardless of Dates of Service must be sent using CPID 6286 for Professional and CPID 5648 for Institutional claims for processing at PGBA.
Claims containing Dates of Service on or before 03/31/2013 must be submitted to the clearinghouse no later than 5:00 PM CT on 7/28/2013 using CPIDs 7452 and 3552 for final processing by WPS. After this time, CPIDs 7452 and 3552 will no longer be valid and claims will reject. Rejected claims for CPIDs 7452 and 3552 must be resubmitted using CPIDs 6286 and 5648 on or after 7/30/2013.
The clearinghouse will continue to receive and process electronic remittance and reports for CPIDs 7452 and 3552 from WPS until claims processing is complete.
Providers should be aware of the final submission date to WPS and prepare to submit all claims to PGBA as of 7/30/2013.
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 28, 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.
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.