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Provider claims

We're committed to serving you with clear policies, efficient service and fast claims turnaround, so you can focus on your patient's well-being.

Billing and filing guidelines

PGBA claims processing is dependent on clean claims from providers. The information in this section is offered to providers to facilitate prompt claims processing.

TRICARE rates

Allowable charges for provider services, including ASCs, OPPs, DRG, and other fee schedule information for DMEPOS and NDC pricing options, are available from the Defense Health Agency website for TRICARE.

TRICARE reimbursement methodologies

The TRICARE Reimbursement Manual provides the methodology for pricing allowable services and items and for payment to specific categories and types of authorized providers.

No government pay list

The no government pay list is made up of procedures and services outside of the scope of TRICARE and are considered “non-covered”. This list is available from the Defense Health Agency website for TRICARE.

Check status of claims

Providers can check the status of their TRICARE claims by provider or beneficiary by logging into Self-Service for Providers.

Claims processor information

For questions or concerns about claims issues, call PGBA at 1-800-403-3950.
For assistance with electronic claims, call PGBA's EDI Help Desk. 1-800-325-5920, option 2.

TRICARE For Life claims

Wisconsin Physicians Service (WPS)/TFL is the TRICARE For Life (TFL) administrator. Contact WPS/TFL at www.TRICARE4u.com or 1-866-733-0404.

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