TriCare East /Tricare West Claim and ERA Changes Coming 2025

campaign There are some upcoming changes we wanted to make you aware of if you are a provider and are credentialed with this insurance.

Transaction Type:

837I and 837P Claims, 835 ERA

Payer ID / Name:

  • 99727 → TriCare East (PGBA)
  • TREST → TriCare East (WPS)
  • 99726 → TriCare West (PGBA)

Effective Date:

calendar_month 1/1/2025

Description:

This notification is to inform you of upcoming changes related to claim and ERA processing for TriCare East and TriCare West. Effective for dates of service on or after 1/1/25, PGBA will be the designated claim processor for TriCare East. As such, claims submitted to TriCare East with dates of service on or after 1/1/25 should be submitted using new payer ID 99727. Submitters impacted by this change must enroll with TriCare East (PGBA) prior to 1/1/25 in order to receive ERAs for claims submitted to payer ID 99727.

You can find the enrollment form located here.

Claims submitted to Tricare East (WPS) through Office Ally with 2024 dates of service must be received by Office Ally no later than April 29, 2025.

Payer ID TREST will no longer be a valid payer ID after this date.

TriCare is also making changes to the regions served by TriCare East and TriCare West, which go into effect on 1/1/25. This means that providers located in Arkansas, Illinois, Louisiana, Oklahoma, Texas and Wisconsin will be part of TriCare West and should submit their claims using existing TriCare West payer ID 99726. Submitters impacted by this change must enroll with TriCare West prior to 1/1/25 in order to receive ERAs for claims submitted to payer ID 99726.

You can find the enrollment form located here.

Provider Action Required:

  • TriCare East (PGBA):  Claims with Dates of Service 1/1/25 and after
    • These should be submitted using payer ID 99727
  • TriCare East (WPS):  Claims with Dates of Service prior to 1/1/25
    • These should be submitted using payer ID TREST
  • TriCare East (PGBA): ERA Enrollment is required to receive Electronic Remittance Advice for new payer ID 99727
    • Please follow the instructions posted on Office Ally's website here
  • TriCare West (PGBA):  Providers in Arkansas, Illinois, Louisiana, Oklahoma, Texas and Wisconsin must enroll in order to receive ERA for claims submitted with dates of service on or after 1/1/25
    • Please follow the instructions posted on Office Ally's website here

Have further questions?

Please reach out to Office Ally here for more information and clarification.

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