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TriCare Payer Update

Pat Stream (Director of Customer Success) 3 years ago in Billing/Electronic Modules updated by crystalp 3 years ago 16

This is an important notice specifically for providers who serve patients with TriCare. As you may have heard, TriCare is changing effective Jan 1, 2018.

What does this mean for you and what you do? In order to continue receiving payments from TriCare, the Procentive Customer Care team has identified steps that are important for your organization to complete before January 1, 2018. The exact steps depend on which TriCare Region you bill to. Please be aware you may need to make changes to more than one region.


If you bill to TriCare West:
(Procentive is switching clearinghouses for this payer)

  • To start/continue receiving ERAs (electronic remittance advice) into Procentive for TriCare West, please complete this form and fax to TriCare (attn: T2017 West EFT/ERA) at (1-888-282-2841).
  • Send the form to Procentive via fax (1-888-354-9053) or upload in a Support Ticket.
  • To receive or continue to receive EFTs (electronic funds transfer) from this payer complete the EFT paperwork again.
  • Verify with TriCare that you are still credentialed with the correct claims processor. If you are not certain who your claims processor is, please call your Provider Representative at TriCare.

If you bill to TriCare North and/or TriCare South:
(They are merging to become TriCare East)

  • To continue submitting claims and receiving payment, enroll for claims submission, ERA and/or EFT by completing the instructions within this document.
  • Once the enrollment steps are complete, then notify Procentive (via a Support Ticket). This step is necessary so that Procentive can complete the process on your behalf.
  • Verify with TriCare that you are still credentialed with the correct claims processor. If you are not certain who your claims processor is, please call your Provider Representative at TriCare.

Please don't hesitate to contact the Customer Care Team via a Procentive Support Ticket if you have questions.

Answer

Answer

Hello All,


Yes, as Debbie has mentioned here, please send in a support ticket if you are experiencing trouble with receiving Tricare ERAs. This way we can troubleshoot your individual situation. 


Thank you,

Customer Care Team

+1

I sent the ERA and EFT paperwork to TriCare West in September. Do I need to send it to Procentive also?

Great Question Melissa!


We do not have an existing copy of your September paperwork so you will need to re-complete the ERA Pre-enrollment for TriCare West. You do not need to re-complete the EFT Pre-enrollment. 


Anyone who completed the TriCare West Pre-enrollment earlier in the year and sent a copy to us should have received a Support Ticket with details. 

Anyone who completed the TriCare West Pre-enrollment earlier in the year but did not receive a Support Ticket this morning will need to re-complete the TriCare West Pre-enrollment.


If you are re-completing the paperwork, or are completing it for the first time, please make sure to send Procentive a copy so we can finalize the enrollment!


Thank you! :)

We've been receiving EFT payments from PGBA Tricare, and we ARE NOT receiving the ERA's to post.  Anyone else having this issue?


Thanks!

Kaii,


Yes. We are experiencing the same issue. I sent a help ticket for support. The clearinghouse is researching the issue. I have not yet heard from them or  the Help Desk Team. I'm patiently and eagerly waiting for a response. This event has impacted claims resolve. 


Debbie

Yes, we are having this same issue as well and I don't know why either.

Good to know I'm not the only one.  I've also responded via ticket when I originally completed the ERA form for Procentive.  

Thanks everyone!

Crossing our fingers for a positive outcome. I encourage others to create a help ticket if you are receiving payments without any remits into the ERA system. It appears to be a global issue, perhaps. 


Debbie

Answer

Hello All,


Yes, as Debbie has mentioned here, please send in a support ticket if you are experiencing trouble with receiving Tricare ERAs. This way we can troubleshoot your individual situation. 


Thank you,

Customer Care Team

I am receiving the PGBA Tricare payments too.  I am not receiving the remits electronically.  Does everyone know how to find the remits so at least you can hand-post?  Below is some helpful instructions... 


www.Tricare-west.com

select "Provider"

Log-in or Register (setting up the password was very challenging)

once your on the Provider page, look at the left side of screen and  select "View and Print Remits"

enter your Tax ID and NPI

In "Location" field enter 1/1/2018

Click the NPI link

Select "Past 60 days"

Click on "view remit" for information.


Hope this Helps!

=)

+1

We submitted all of the paperwork for both Tricare East and West when that memo came out about it. Since the switch over on 1/1/18, we have started receiving paper checks and claims from Tricare West...Even before the switch they were being automatically paid into our account so I am not sure what happened. Luckily the new website is very easy to use!

Thank you, Paula!  This is helpful!

We have NOT received any ERAs for service dates in 2018. We are receiving ERAs for 2017 service dates. I called Tricare a couple weeks ago and the rep found some of our claims for one of our clients and said that mental health claims were pending due to a pricing issue (they are trying to figure out what the rates should be, I guess). She said claims should be processed/paid near the end of the month. I'm happy they received our claims but I'm still worried about not getting ERAs for them. My co worker just confirmed that there are some Tricare EFTS that do not have an ERA. 


Can any of you pinpoint a date range of when you started to receive EFTS from Tricare but no ERA? 

Began receiving EFT on 2/21/2018 from Tricare and NO ERA.

Received EFT and ERA's for dates of service prior to 1/1/2018 from 1/13/2018 through 01/24/2018.  

Have not received any ERA's since 01/24/2018.

Also, does anyone's claims seem to be processing differently than before for 2018 service dates? I just printed my remits and at a glance some clients have a $31, $25, $41 , $25, $38.88 'co pay'. It's not listed under the cost share column.  If it was listed as deductible, then it might make sense but I know the deductible year is Oct to Sep, so that would not make sense in this case either. 


I guess a new administrator does not come without issues, right?!

We received our first EFT's, just last week.  This week, there were quite a few more. Again no ERA's

I am receiving paper checks as well.