Humana Military's claim processor will switch from Wisconsin Physicians Service (WPS) to PGBA LLC, effective January 1, 2025.

Key Changes:

EDI Claims:

• The 2025 TRICARE East Payer ID is 99727

Claims and Document Submissions:

• Starting January 1, 2025, use XPressClaims via provider self-service

Clearinghouse Requirements:

• New submitters must file a Trading Partner Agreement and Enrollment Form to obtain a          mailbox/submitter ID
• Confirm Payer ID 99727 is enabled if your clearinghouse already files claims to PGBA
• If your clearinghouse does not submit to PGBA, files can be uploaded directly if they meet ANSI     X12 standards.
• Batch claims processing is available through the EDI Gateway mailbox system.
• Complete a PGBA EDI Provider Agreement to submit claims electronically

Claims with 2024 Dates of Service (DOS)

• WPS will process claims with 2024 DOS until April 30, 2025
• After April 30, 2025, submit 2024 claims via XPressClaims or the clearinghouse.
• Ensure all documentation and disputes are submitted promptly before April 30, 2025.

ERA/EFT Enrollment:

• Re-enroll in ERA/EFT by January 1, 2025 even if currently enrolled. (click 'I am staying in East Region'). 
• Note: T17 EFT/ERA applications will no longer be accepted after this date.

Source: Tricare EFT Changes Coming in 2025

"A picture is worth a thousand words." 

Does your practice accept Cigna insurance? We have learned of an important policy change:

You play a crucial role in testing, treating and vaccinating uninsured individuals, or those with limited health care coverage.