PGBA may delay or deny claims for a number of reasons. These resources offer tips to help facilitate prompt claims processing.
PGBA, LLC is the claims processor for TRICARE South Region. Visit PGBA’s website at my.tricare.com for more information about claims processing for TRICARE.
TRICARE network providers must file all claims electronically using one of our EMC options.
TOP providers can access referrals, claims, forms and other information securely on the provider portal.
Home infusion drugs are reimbursed according to TRICARE policy using HCPCS codes and NDC for pricing.
Provider FAQs about submitting claims for autism services.
TRICARE requires providers to file claims electronically with the appropriate HIPAA-compliant standard electronic claims format.
DME claims submitted for “rental to purchase” items require the appropriate modifier in order to track and calculate the monthly rental rate.
Find NDC pricing and filing tips for the prompt payment of provider office injectables.
ClaimCheck is a review system that audits claims for correct coding of Current Procedural Terminology (CPT) and HCPCS procedure codes.