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TRICARE East Region

Information and timeline for TRICARE East provider claims

Humana Military was awarded the new East Region contract for TRICARE with an effective date of January 1, 2018. Wisconsin Physicians Services (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, Texas (excluding El Paso area), Vermont, Virginia, West Virginia and Wisconsin.

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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 provider’s 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.

Provder EDI Self-Registration

Important: Direct Submitters are required to complete an inititial 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.

Important: Trading Partners who prefer to receive 835s directly are required to complete an inititial 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.

    Alternate online claims entry portal

    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, provider’s will need to complete a Provider EDI Self-Registration form. When completing the Provider EDI Self-Registration form, please be sure to enter the ‘Submitter ID’ as WEBTRIEAST and the ‘Submitter Name’ as TRICARE East to enable on-line claim submission access. Also, please select ‘5010 837 Professional Claim Inbound’ in the Transaction Information section

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

    Please note: No LIVE claims submissions to WPS from current TRICARE East Region providers are allowed until January 1, 2018