Claims processing standards

TRICARE requires providers to file claims electronically with the appropriate HIPAA-compliant standard electronic claims format. Non-network providers submitting paper claims must use either a CMS-1500 (professional charges) or a UB-04 (institutional charges) claim form.

The NPI is a 10-digit number used to identify providers in standard electronic transactions. It is a HIPAA requirement. Providers must submit the appropriate NPI on all HIPAA-standard electronic transactions. Both billing NPIs and rendering provider NPIs, when applicable, are required when filing claims. Providers treating TRICARE beneficiaries as a result of referrals should also include the referring provider’s NPI on transactions, if available, per the implementation guide for the transaction.

Both individual providers (Type 1) and organizational providers (Type 2) should register all NPIs with Humana Military. Register your NPI online now

TRICARE claims information