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XPressClaim®

XPressClaim sets the standard for online claims submission. Designed with the provider in mind, XPressClaim is easy to use, fast and free. Most of the time, you'll get instant results and be able to print a Patient Summary Receipt to give to your patient on the spot. For those claims that cannot be processed immediately, you'll still receive priority processing. Using XPressClaim is much faster than other claims submission options.

Benefits of using XPressClaim: 

  • XPressClaim lets you see immediately if a patient is eligible for TRICARE coverage.
  • There are no transaction fees to submit a TRICARE XPressClaim. You don't have to pay an Electronic Data Interchange (EDI) company or its claims "clearinghouse" to handle your transactions.
  • There's no software or hardware to buy (other than using your existing office personal computer(s) and Internet connection service).
  • When you see the message "Your finalized XPressClaim." and it shows an amount allowable to be paid, you can generally expect a check to be mailed to you within 5–15 days.
  • You can then quickly enter the results into your accounts receivable practice management system, which helps you settle your accounts faster.

Getting Started

If you haven't already registered as a provider on www.tricare-west.com, you will need to do so in order to submit claims electronically through XPressClaim. You'll find XPressClaim is one of many web-based self-service options that make it easier to manage your TRICARE business. Once you have an account on www.tricare-west.com, log in and select 'Manage TIN' from the 'My Account' menu. Select XPressClaim for the Tax ID Number, agree to the terms in the TRICARE XPressClaim Agreement and click the SIGNUP button. If you have multiple locations or multiple providers, you can set up your XPressClaim file by location, by city, by provider or even by specialty. Now you're ready to start submitting claims electronically.

Visit our Online Provider Education page and watch our XPressClaim tutorial on how to submit professional or institutional claims electronically. 

System Requirements

To run XPressClaim on your computer, you will need an Internet connection. We recommend the Internet Explorer 11 browser. XPressClaim works under Microsoft Windows 95, 98, ME, NT, 2000, or XP operating systems. XPressClaim is also compatible with the current Apple Mac operating system. Although not required, we recommend a fast Internet connection speed for best results. Please make sure that you browser security setting is set to disable pop-up blockers. Please note that our site functions are not compatible with tablets and other mobile devices.

Filing Claims

  1. Log in at www.tricare-west.com.
  2. Select 'Submit a Claim' from the menu bar. You can submit professional and institutional claims. View our Guide to Keying Claims for additional information.
  3. In the XPressClaim system, select the location where the patient received care, the doctor who provided it and the patient who received it. (Tip: Use the TAB key to move to the next field when keying information.)
  4. Enter the services and charges for your claim. (You can submit corrected claims, too.) You can submit up to 50 lines of information in one XPressClaim.
  5. Click 'Submit,' make any online corrections and get your claim results right away. You will receive a message that tells you if the claim has been accepted for processing, if there are any errors or missing information and how the claim was processed. If a claim is more complicated and needs to be resolved, dedicated associates will process the claim as a priority. Most often, such claims will complete within 10 days or less. 

Secondary or Corrected Claims

You can submit new, secondary and void/replacement claims. When keying void/replacement claims, select '7-Replacement of prior claim' or '8-Void/cancel of prior claim' from the 'Claim frequency' dropdown menu. You will also need to enter the Payer Claim Control Number. 

Additional Information

  • NDC numbers: The NDC number is the National Drug Coding Number (NDC#). XPressClaim requires an NDC# when you submit a procedure code for an injection or a drug when there isn't an established TRICARE Maximum Allowable Charge. An NDC# is required for all injectable home infusion drugs. 
  • Authorization numbers: If the authorization number is on file with TRICARE, you do not need to enter the authorization number – XPressClaim will enter it automatically.  
  • Claim notes: Supplemental information can be added to an entire claim or a claim line. Before submitting the claim for processing, select "No, I have supplemental claim and/or line data to enter." Examples of supplemental claim information include additional notes, applied behavior analysis (ABA) session times, unlisted code descriptions, and rendering provider information.  
  • Other health insurance (OHI) information: To submit OHI information on an XPressClaim, begin by entering the primary payer’s amount paid in the "OHI Paid' box on the 'Enter the professional claim line details' screen. Enter claim/line adjustments to indicate patient responsibility amount(s) and reason codes on the 'Enter other health information' screen. Enter 'Other payer information' using the dropdown boxes and select 'Continue with XPressClaim.' 
  • Multiple Dates of Service: You can easily submit multiple dates of service on a professional claim. XPressClaim defaults each line item to today's date, but you can easily change it to past dates, or even different dates for each line item. 
  • Batch Claims: XPressClaim is not a batch claim system. It is a one claim at a time product built on the assumption that provider's would/could use it while the patient is still in their office. For batch claim systems, providers should use 837 transactions. 
  • Supplemental data: To add supplemental data such as the referring provider or supervising provider information in XPressClaim, choose the “No, I have supplemental claim and/or line data to enter” button at the end of your claim entry. Select the appropriate checkbox from the “Supplemental claim information” page to add this information. The page will re-display with the fields related to the checkbox selected. Complete the corresponding fields and select, “Continue with XPressClaim.” You will then have the option to enter line-level supplemental data. 
  • Additional Documents: You cannot directly attach supporting documents to a claim. However, you can go to the 'Upload Documents' feature to send us additional documentation.

 

XPressClaim® is registered trademark of PGBA, LLC.