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