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 TRICARE contractors and other healthcare payers are prohibited from accepting or issuing transactions that do not meet HIPAA standards.

To avoid cash-flow disruptions, it is imperative that providers use the HIPAA-compliant claims formats. For assistance with HIPAA standard formats for TRICARE, call WPS Electronic Data Interchange (EDI) Help Desk at (800) 782-2680, option 1.

TRICARE claims information