Other Resources

EMC Help Desk
PGBA operates an EMC Help Desk to assist you with any issues related to TRICARE electronic claims submissions. The telephone number is 1-800-325-5920. When you call, be sure to identify yourself as a TRICARE provider.

Hard Copy Supporting Documentation
Did you know that TRICARE claims that require some type of hard copy supporting documentation can still be filed electronically? PGBA has a dedicated fax to receive supporting documentation for electronically submitted claims. There is an EMC Attachment Form that you should use in order to ensure that the documentation is correctly matched up to your claim.

TRICARE Provider IDs
In order to ensure correct claims payment, it is important that your claims be filed with the correct TRICARE Provider ID. The TRICARE Provider ID consists of your Tax ID with a possible 3-digit suffix.  If you have multiple office locations, each office location will have a different suffix. The suffix may also be used to distinguish departments within an institution (i.e. psych unit vs. medical/surgical). If you do not know your TRICARE Provider IDs, contact your Humana Military Provider Relations Representative. Including the appropriate office location suffix will ensure your check is mailed to the correct address.

On professional claims (CMS-1500) submitted by a group practice, the Rendering Physician ID must be submitted on each line of the claim. Note that this is a different number than the TRICARE Provider ID previously discussed. It is typically the SSN of the physician who rendered the service.

EMC Response Reports
To ensure that your electronic TRICARE claims are accepted by PGBA’s system for processing, it is imperative that you reconcile your EMC transmissions with the EMC response reports returned by PGBA for every transmission. These responses show you the claims that were rejected as well as the claims that were accepted for processing. Reviewing these responses will ensure that EMC transmissions are not lost, and that rejected claims are identified so you can correct and resubmit them electronically for processing.

If your TRICARE claims are submitted through a clearinghouse or other vendor, the PGBA responses are returned to that entity. Note that many clearinghouses perform their own edits and create their own reports which show how many claims were received from the provider and forwarded on to the payer, but only the PGBA responses show you which claims were received and accepted by PGBA for processing. If you are not sure if you are receiving these PGBA EMC responses, contact your vendor or the PGBA EMC Help Desk at 1-800-325-5920.

Common EMC Rejects
Here you will find a listing of the most common EMC Reject Reasons and Solutions.