TRICARE provider tools

Electronic claims

We know your time is valuable. Save time and money by enrolling in electronic processing today.

For faster claims processing, providers can now attach supporting documents when submitting electronic claims through self-service. We encourage providers to use the electronic claims process rather than using fax or secure messaging to submit additional documentation.

Alternate online claims entry

Provider self-service allows TRICARE East providers to enter and submit primary and secondary claims.


Set-up Electronic Data Interchange (EDI)

All electronic providers/groups must sign, and have on file, a Trading Partner Claims Agreement (“Agreement”) prior to submission of electronic claims.

All providers that will submit EDI claims will need to complete a self-registration process that includes an initial registration and the necessary request forms and business agreement(s).

Begin the registration process

 

Request form and business agreement overview

Depending on your submitter type, you will need to complete request forms and business agreements after you have registered. They include:

  • Trading partner/submitter ID enrollment information form
  • Connectivity agreement (Required for ALL trading partners)
  • Clearinghouse agreement (Required ONLY for clearinghouses)
  • Line of Business/Transaction (LOB/TXN) configuration edit form (used to setup the various lines of business and types of transactions each trading partner will be utilizing)
  • A separate LOB/TXN Configuration Edit Form is required for each line of business and transaction combination
  • Provider EDI registration
  • Provider agreement (a separate agreement is required if registering for both Medicare and non-Medicare lines of business)
  • Provider Electronic Remittance Advice (ERA) Agreement (optional)
  • Provider Electronic Funds Transfer (EFT) Agreement (optional)
  • Line of Business/Transaction (LOB/TXN) Production Approval Form (to be completed by direct submitters once a successful test file has been submitted)
  • A separate LOB/TXN Production Approval Form is required for each line of business and transaction combination

Please note: LOB/TXN Production Approval form is not required for ERA or EFT.


ERA and EFT available

Electronic Remittance Advice (ERA) is an electronic version of your explanation of payment or electronic remittance and allows you to automatically post your accounts.

Electronic Funds Transfer (EFT) is an electronic version of your paper check deposited directly into your checking or savings account.

Register for ERA and EFT

The new TRICARE East Region payer ID is TREST. It will need to be placed in the following data elements within your X12 837 claim files:

  • ISA-08
  • GS-03
  • NM1-09 (with 40 qualifier)

We also encourage you to contact your clearinghouse, billing service or software vendor to discuss transition-related issues. A submitter (or trading partner) is someone who sends and receives electronic files. A submitter may be a provider and/or a clearinghouse.


Contact EDI helpdesk for assistance