Provider Resources



TRICARE EDI


TRICARE For Life Electronic Claims Submission

WPS administers the TRICARE For Life program. We are pleased to announce that your TRICARE For Life claims may now be submitted electronically. While most TRICARE For Life claims are electronically crossed from Medicare, some are not – including situations such as the beneficiary having a Medicare Advantage Plan. We also understand that providers' practice management systems/software require claim submission in certain situations (i.e., if claim payments are not received within a certain number of days, etc.). When these situations occur, WPS encourages you to take advantage of the benefits of electronic claim submission.

If you are a provider that is new to WPS, please visit our Getting Started page to choose your claim filing option.

If you are a non-Medicare certified provider, you can now submit your claims electronically through our online internet claim entry application available at the TRICARE4U website. You can also view or print your claim payment information. To use the TRICARE4U website, you will need to enroll on our Website Enrollment page.

TRICARE For Life Electronic Funds Transfer (EFT)

In order to initiate EFT, you must choose between receiving ERA or utilizing the TRICARE4u.com website. To enroll for these options, see the Electronic Remittance Advice (ERA) section below.

Electronic Funds Transfer (EFT) is now available for TRICARE For Life providers. EFT replaces the paper checks you currently receive for TRICARE For Life claim payments. This process allows your payment to be deposited directly into your checking or savings account, and eliminates the delay or inconsistencies you may encounter with mail procedures.

EFT payments are typically deposited into your specified bank account two business days following the Defense Health Agency (DHA) budget approval. Electronic Funds Transfer payments have a different number sequence than your current paper checks.

The number of EFT transactions initiated by WPS is dependent on the number of bank accounts to which your office requires EFT payments to be posted. If you currently use more than one legacy provider number or NPI, there will be more than one EFT transaction per day.

To enroll in Electronic Funds Transfer (EFT), visit our Enrollment page.

Electronic Remittance Advice (ERA)

Electronic Remittance Advice (ERA) is an electronic version of your Explanation of Benefits and allows you the ability to automatically post to your accounts, minimizing data entry by eliminating your manual posting procedures.

When you choose to receive Electronic Remittance Advice or ERA, your files will be sent to you in the ANSI (American National Standards Institute) X12 835 format (version 5010A1) and can be downloaded from the WPS Gateway Express or from your clearinghouse/billing service depending on how you choose to enroll.

Visit the WPS Community Manager forms page for more information on the available options to enroll for Electronic Remittance Advice (ERA).

Important Information

You can also choose to register on the TRICARE website to view or print your claim payment information.

TRICARE Overseas Program

The TRICARE Overseas Program (TOP) is the Department of Defense health care program for geographical areas and territorial waters outside the United States. While similar to the stateside program, TOP has some differences. TRICARE partners with the best available providers around the world and has established host nation provider networks around military hospitals and clinics and in many remote locations as well.

International SOS Government Services, Inc. (International SOS) administers the TOP benefit. For more information about overseas benefits, visit the TOP Web site. Call your TOP Regional Call Center for assistance with enrollment, referrals, and prior authorizations.

If interested in becoming an electronic trading partner with WPS for your TRICARE Overseas claims, visit Getting Started to begin the enrollment process.

Information and timeline for TRICARE East provider claims

Humana Military was awarded the new East Region contract for TRICARE with an effective date of Jan. 1, 2018. Wisconsin Physicians Service Insurance Corporation (WPS) will be the new fiscal intermediary/claims processor for TRICARE in the new East Region. The new East Region is a merger of the existing TRICARE North and TRICARE South Regions, which includes the following states: Alabama, Arkansas, Connecticut, Delaware, the District of Columbia, Florida, Georgia, Illinois, Indiana, Iowa (Rock Island area), Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Mississippi, Missouri (St. Louis area), New Hampshire, New Jersey, New York, North Carolina, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas (excluding El Paso area), Vermont, Virginia, West Virginia, and Wisconsin.

View Region Map

TRICARE East Region (EDI) Electronic Claims Submission

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

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

Provider EDI Self-Registration is an option that is available for providers to self-register when using a third party for electronic claims submission. This process does not require the provider to have an account in WPS Community Manager.

This form allows registration and management of the provider’s facility, including EDI registration and deactivation by the provider without going through the third party to enroll.

Providers identify submitters/clearinghouses through which they will be sending their claims transactions.

Provider EDI Self-Registration

Important: Direct Submitters are required to complete an initial registration through WPS Community Manager before enrolling for any Line of Business (LOB) and Transaction combinations. You can access the WPS Community Manager tab under the EDI Home menu.

TRICARE East Region Electronic Funds Transfer (EFT)

Electronic Funds Transfer (EFT) replaces paper checks. This process allows your payment to be deposited directly into your checking or savings account, and eliminates the delay or inconsistencies you may encounter with mail procedures.

EFT payments are typically deposited into your specified bank account two business days following the Defense Health Agency (DHA) budget approval. Electronic Funds Transfer payments have a different number sequence than your current paper checks.

The number of EFT transactions initiated by WPS is dependent on the number of bank accounts to which your office requires EFT payments to be posted.

Enroll for Electronic Funds Transfer (EFT)

Electronic Remittance Advice (ERA)

Electronic Remittance Advice (ERA) is an electronic version of your Explanation of Benefits and allows you the ability to automatically post to your accounts, minimizing data entry by eliminating your manual posting procedures.

When you choose to receive Electronic Remittance Advice or ERA, your files will be sent to you in the ANSI (American National Standards Institute) X12 835 format (version 5010A1) and can be downloaded from the WPS Gateway Express or from your clearinghouse/billing service depending on how you choose to enroll.

Provider Management of ERA Enrollment

Important: Trading Partners who prefer to receive 835s directly are required to complete an initial registration through WPS Community Manager before enrolling for any Line of Business (LOB) and Transaction combinations. You can access the WPS Community Manager tab under the EDI Home menu.

Electronic Remittance Advice (ERA)

The Humana Military secured provider portal will offer an online claims entry option that will allow TRICARE East providers to enter and submit claims.

Before submitting claims on the Humana Military secured provider portal, providers will need to enroll on our website Enrollment page.

More information will be provided when the online option becomes available.

   

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