Welcome

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. Electronic claims are faster than paper claims, so you get paid faster. Electronic filing also saves you time and money.

Note: 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.

Supporting documents, such as the beneficiary's other health information (OHI) or a certificate of medical necessity (CMN), can be attached to an electronic claim submission. 

*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 right on the Internet, and it's fast and free!

Learn more on our XPressClaim page.

Greater than 150 claims per month Submit claims to other payers as well as TRICARE using the list of approved vendors/clearinghouses.
Bundle Processing 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.

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 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.