Billing and filing guidelines

PGBA may delay or deny claims for a number of reasons. These resources offer tips to help facilitate prompt claims processing.

TRICARE claims guidelines

PGBA, LLC is the claims processor for TRICARE South Region. Visit PGBA’s website at for more information about claims processing for TRICARE.


TRICARE network providers must file all claims electronically using one of our EMC options.

TRICARE overseas - foreign claims

TOP providers can access referrals, claims, forms and other information securely on the provider portal.

Home infusion injectable

Home infusion drugs are reimbursed according to TRICARE policy using HCPCS codes and NDC for pricing.

CACD autism filing tips

Provider FAQs about submitting claims for autism services.

Claims processing standards and HIPAA guidelines

TRICARE requires providers to file claims electronically with the appropriate HIPAA-compliant standard electronic claims format.

"Capped DME" rental to purchase guidelines

DME claims submitted for “rental to purchase” items require the appropriate modifier in order to track and calculate the monthly rental rate.

Office injectable

Find NDC pricing and filing tips for the prompt payment of provider office injectables.

TRICARE claims auditing

ClaimCheck is a review system that audits claims for correct coding of Current Procedural Terminology (CPT) and HCPCS procedure codes.