Claims processing standards and HIPAA guidelines

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

All claims must be submitted electronically in order to receive payment for services. 98% of claims must be paid within 30 days and 100% within 90 days. All claims for benefits must be filed no later than one year after the date the services were provided.

HIPAA transaction standards and code sets: Providers must use the following HIPAA standard formats for TRICARE claims: ASC X12N 837—Health Care Claim: Professional, Version 5010 and Errata and ASC X12N 837—Health Care Claim: Institutional, Version 5010 and Errata. For assistance with HIPAA standard formats for TRICARE, call WPS EDI Help Desk at (800) 782-2680 (option 1). 

Network providers can submit new claims and check the status of claims online using provider self-service.