TRICARE West region
Effective January 1, 2018, the new Tricare West contractor will be Health Net Federal Services (HNFS). All Tricare West providers must secure new contracts with HNFS as UnitedHealthcare will no longer retain this contract. PGBA will remain the claims processor and there will be no disruption to electronic claim transmissions.
The new West region will include the following states: Alaska, Arizona, California, Colorado, Hawaii, Idaho, all of Iowa except the Rock Island Arsenal area, Kansas, Minnesota, all of Missouri except the St. Louis area, Montana, Nebraska, Nevada, New Mexico, North Dakota, Oregon, South Dakota, West Texas, Utah, Washington and Wyoming.
To facilitate a smooth transition, providers must take the required actions below. You can find more information about each process below.
- Contracting: Complete a new provider contract with Health Net Federal Services.
- EDI: No action required. Per PGBA, Payer ID and EDI agreements will remain in place through the transition.
- ERA: Enroll by completing the T2017 West Region Electronic Remittance Advice Enrollment
- EFT: Enroll by completing the T2017 West Region Electronic Funds Transfer Pre-Enrollment
The HNFS EDI department indicated they sent packets on August 7th and August 12th with the above information. If you did not receive your transition packet, you are encouraged to call the EDI department to ensure HNFS has accurate contact information for your company.
First step: Tricare West providers must first complete a new provider contract with Health Net by sending an email to [email protected] to request an HNFS West Region Contract. The email must include:
- Provider/organization name, street, city, state, ZIP code
- Type of provider (for example, DME supplier, home health agency)
- Tax Identification Number (TIN)
- Point of contact name/title, telephone number, email address, and fax number
Next, providers must complete and fax both ERA and EFT enrollment forms to HNFS to receive electronic remittance advices and electronic payments.
If providers have any additional questions, or want to check on their enrollment status, they can call the HNFS EDI department at (855) 200-0756.
TRICARE North region
Effective January 1, 2018, the Tricare North and South regions will merge to form the new Tricare East region. Tricare North’s contractor is changing from Health Net Federal Services (HNFS) to Humana Military. The new claims processor will be Wisconsin Physician Services (WPS).
The new East region will include the following states: Alabama, Arkansas, Connecticut, Delaware, the District of Columbia, Florida, Georgia, Illinois, Indiana, Iowa (Rock Island area), Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Mississippi, Missouri (St. Louis area), New Hampshire, New Jersey, New York, North Carolina, Ohio, Oklahoma, Pennsylvania, South Carolina, Tennessee, Texas (excluding El Paso area), Vermont, Virginia, West Virginia, and Wisconsin.
Providers must take the required actions below to ensure a successful transition. You can find more information about each process below.
- Contracting: No action required; Contracts will transfer automatically.
- EDI: Enroll by completing the Provider EDI Self-Registration
- ERA: Enroll by completing the Provider Management of ERA Enrollment
- EFT: Enroll by completing the Provider Management of EFT
Tricare North providers will not have to complete new provider contracts with Humana Military, as HNFS and Humana Military agreed to transition current contracts effective January 1, 2018.
Regardless of prior affiliation with this payer, all providers must complete a new EDI agreement and register with WPS in order to transmit claims to the new Tricare East region beginning January 1, 2018. If you use a clearinghouse or third party to transmit claims, you will need to start the registration process through your clearinghouse before completing the online EDI agreement. Check with your billing software and clearinghouse to verify this process.
An EDI staff member indicated the electronic payer ID they want to use is “TREST”. The tentative address for claims will be PO Box 7981 Madison, WI 53707. Because this will be a new payerID, many clearinghouses are experiencing challenges with proactive enrollment. Providers are encouraged to contact their clearinghouse to ensure they are using the correct Tricare East payer ID, and you may experience some delays if your clearinghouse cannot initiate enrollment.
Once the provider completes the WPS EDI agreement process, they will need to enroll for Electronic Remittance Advice (ERA) and Electronic Funds Transfer (EFT) by completing the online forms.
WPS Enrollment Resources:
If providers have any additional questions, or want to check on their enrollment status, they can call the WPS EDI department at (800) 782-2680, Option 1 or Humana Military at (800) 444-5445, Option 2.
TRICARE South region
Effective January 1, 2018, the Tricare South and North regions will merge to form the new Tricare East region. Tricare South’s contractor will remain the same: Humana Military. The new claims processor will be Wisconsin Physician Services (WPS).
The new East region will include the following states: Alabama, Arkansas, Connecticut, Delaware, the District of Columbia, Florida, Georgia, Illinois, Indiana, Iowa (Rock Island area), Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Mississippi, Missouri (St. Louis area), New Hampshire, New Jersey, New York, North Carolina, Ohio, Oklahoma, Pennsylvania, South Carolina, Tennessee, Texas (excluding El Paso area), Vermont, Virginia, West Virginia, and Wisconsin.
Providers must take the required actions below to ensure a successful transition. You can find more information about each process below.
- Contracting: No action required.
- EDI: Enroll by completing the Provider EDI Self-Registration
- ERA: Enroll by completing the Provider Management of ERA Enrollment
- EFT: Enroll by completing the Provider Management of EFT
Tricare South providers will not have to complete new provider contracts with Humana Military, as the contractor will not change for this region.
Regardless of prior affiliation with this payer, all providers must complete a new EDI agreement and register with WPS in order to transmit claims to the new Tricare East region beginning January 1, 2018. If you use a clearinghouse or third party to transmit claims, you will need to start the registration process through your clearinghouse before completing the online EDI agreement. Check with your billing software and clearinghouse to verify this process.
An EDI staff member indicated the electronic payer ID they want to use is “TREST”. The tentative address for claims will be PO Box 7981 Madison, WI 53707. Because this will be a new payerID, many clearinghouses are experiencing challenges with proactive enrollment. Providers are encouraged to contact their clearinghouse to ensure they are using the correct Tricare East payer ID, and you may experience some delays if your clearinghouse cannot initiate enrollment.
Once the supplier completes the WPS EDI agreement process, they will need to enroll for Electronic Remittance Advice (ERA) and Electronic Funds Transfer (EFT) by completing the online forms.
WPS Enrollment Resources:
If providers have any additional questions, or want to check on their enrollment status, they can call the WPS EDI department at (800)-782-2680, Option 1 or Humana Military at (800)-444-5445, Option 2.
This valuable content was written by Andrea Stark, founder of MiraVista, LLC, a billing and reimbursement consulting firm based out of Columbia, SC for Coding Leader customers.
To contact the author directly please email [email protected]. Or, you may contact Coding Leader at 800-767-1181 or [email protected].