Claims Submission
National Provider Identifier
Health Net Federal Services offers payments and remittances by National Provider Identifier (NPI) number. The NPI billed on the claim will determine where payment and remittance will be sent. Visit our NPI forms page to print and complete the West Region NPI form.
Electronic Claims Submission
TRICARE network providers must file 100 percent of their TRICARE claims electronically.* We encourage non-network providers to take advantage of this feature as well.
- Save time and money. Electronic claims are faster than paper claims, so you get paid faster.
- Attach supporting documents such as the beneficiary's other health insurance (OHI) information or a certificate of medical necessity (CMN) to your electronic claim submission. See 'Claims with Attachments' below.
*Network providers in the state of Alaska are not required to submit claims electronically.
Filing Options
| Less than 150 claims per month |
XPressClaim is your best option. You can enter your claims online, and it's fast and free!
Learn more on our XPressClaim page.
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| Greater than 150 claims per month |
Submit claims to other payers as well as TRICARE using the list of approved vendors/clearinghouses. |
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| Bundle Processing |
Bundle processing, also known as batch processing, is available through our EDI Gateway mailbox system. View the Gateway user manual to see if this option is right for you. Download the Electronic Data Interchange (EDI) forms. |
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CORRECTED CLAIMS
When submitting corrected claims, be sure to include all line items for that specific claim. This includes any services that may have paid on the original claim submission. Please review our Submitting Corrected Claims page for details.
Electronic Data Interchange (EDI) Resources
EDI Provider Trading Partner Agreement
PGBA Payer IDs for TRICARE
Please contact your clearinghouse or vendor to make sure they are using the correct payer ID. They may have a proprietary ID for you to use prior to submitting claims to PGBA, LLC (HNFS' partner for claims processing).
- TRICARE West Region Payer ID: 99726.
- Note: If your clearinghouse is Change Healthcare, the West Region payer ID is SCWI0 for professional claims and 12C01 for institutional claims. Please call your Change Healthcare representative if you have questions (1-877-469-3263).
Companion Guides
Additional Assistance with EDI
Didn't find the answer you need? Contact the TRICARE EDI Help Desk for the West Region at 1-800-259-0264 or send an email to EDI.TRICARE@pgba.com.
Paper Claims Submission
Non-network providers and all providers in the state of Alaska have the option to submit paper claims by mail; however we encourage you to submit electronically to save time and money.
Mail your claim to:
TRICARE West – Claims
PO Box 202112
Florence, SC 29502-2112
Claims with Attachments
Claims with supporting documentation, such as an Explanation of Benefits (EOB) or Certificate of Medical Necessity (CMN), can be sent electronically (recommended) or via paper submission.
To expedite claims processing, use the “Upload Documents" feature on our secure portal. Once logged in, follow the prompts to choose a category and document type from the drop-down menus.
Claims with supporting documentation include:
- claims for patients who have other health insurance (OHI) and you need to include the OHI EOB
- claims with medical documentation
- claims with a CMN
- claims with possible third party liability (TPL) and you need to include the patient-signed DD Form 2527 TPL form
- corrected claims with attachments
Learn more on our XPressClaim page.
