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PGBA introduces north region providers to myTRICARE claims. Use the Web to: Check authorizations and referrals status Verify patient information, such as eligibility,OHI, PCM name, cat cap and deductible status Check TRICARE claims status View and print remits
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PGBAintroducesnorth region providers to myTRICARE claims Use the Web to: • Check authorizations and referrals status • Verify patient information, such as eligibility,OHI, PCM name, cat cap and deductible status • Check TRICARE claims status • View and print remits • Send ussecure, confidential questions to AskUs with themyTRICARE secure mailbox • Modify your account information • View/sort information for all your TRICARE patients in dataMart • Receive TRICARE payments faster using Electronic Funds Transfer (EFT) • Submit both CMS 1500 and UB-92 claims through XPressClaim
To become a member of myTRICARE claims • Select Register now.
Three steps to gain secure access • Select Are you a TRICARE provider? • Read and accept the terms and conditions • Once you complete the registration process, you will be mailed a security key code to access myTRICARE claims
You are ready to sign into myTRICARE claims • You’ll see this Sign In link in the upper left navigation bar from any page on our Web site. • When you click the Sign In link, the lower box will appear. • As a member, you'll access myTRICARE claims by entering your username and password, then clicking the Sign In button.
Patient information • View patient real-time eligibility, OHI, cat cap and deductible information
View of patient information • Real-time eligibility status • Patient’s PCM (primary care manager) name • Link to patient’s deductible and out-of-pocket information • Link to patient’s OHI information
Claim status • Ability to account for status of all claims submitted (in process, processed, transferred/returned, denied) • View specific patient and payment information on processed claims
Claim status - claims summary • Select Details next to the claim you would like to see more information * The above claim numbers are not actual claims
AskUs – no phone calls necessary! • Ask any questions online that you would call us on the telephone about • Receive answers in your secure online mailbox most often within 2 days
Email notification • We’ll send you an email when there is new information in your mailbox
Mailbox • View your questions and PGBA responses submitted through AskUs • Serves as online library for future reference • Search and file mail (new, old and deleted folders) • Search by Subject function is beneficial when large volume of questions/responses is required
Authorizations and referrals status • View your patients’ authorizations and referrals online
Remits - view and print • TRICARE Payment Summary Voucher – the same as what would be mailed to you, only available sooner and to the multiple users of your account
Go 100% Electronicwith EDI, EFT and ERA! • Submit ALL your claims electronically • Sign up for EFT on myTRICARE.com • Sign up for ERA (electronic remittance advice) • For information concerning any of the above, call 1-877-EDI-CLAIM
dataMart • Create a unique dataMart report that best suits your needs • View claims information for all your TRICARE patients for one or more locations • Sort information the way you want it – by date range, patient’s name, completed claims, etc.
Patient’s name Patient account # Claim # Claim status Patient’s responsibility Billed amount Allowed amount Paid amount Check number Claim details All the information you need in one place
Search claims by status • You may choose the way you want to search claims by status in the report • Completed, In Process, Returned/Transferred, or All
Create your report according to your needs • 4 easy steps • Choose the locations you want included in this report • Add them to the report • Choose the dates of information you would like included in the report • Select how you would like to sort the report (patient’s name, patient’s account number, completed date, etc.)
How to read your dataMart report for completed claims • The tabs let you choose to view claims by status. Example: Completed • All of these claims have completed processing and remits or TEOBs have been sent to the customer. • The left column displays the information the way you selected it. Example: Patient’s name • You can scroll to find the specific name you’re looking for in alphabetical order. • The center section lists the claims detail as well as summary information about the claim • See example on next slide
How to read your dataMart report for in-process claims • The tabs let you choose to view claims by status. Example: In-Process • All of these claims are in PGBA’s system but have not yet completed processing. • The left column displays the information the way you selected it. Example: Patient’s account number • You can scroll to find the specific name you’re looking for in alphabetical order. • The center section lists enough basic information about the claim to determine if this is one you’re looking for (date of service, billed charge, etc.) • See example on next slide
How to read your dataMart report for returned/transferred claims • The tabs let you choose to view claims by status. Example: Returned/Transferred • These claims have been returned to the customer for further information or transferred to the appropriate claims processor for that customer. • The left column displays the information the way you selected it. Example: Patient’s name • You can scroll to find the specific name you’re looking for in alphabetical order. • The center section lists only basic information about the claim as well as where the claim was transferred or the reason the claim was returned to the customer. • See example on next slide
Example of dataMart Excel report You can sort & filter within Excel
XPressClaim • Secure, easy, fast and free • Submit claims on the internet and receive instant results 24 hours a day • Print a patient summary receipt on the spot, while your patient is still in the office • Receive your TRICARE payment faster • Submit UB92 claims
XPressClaim Select the XPressClaim tab from the provider welcome page.
Select the patient who received care You can add a new patient to your directory, quickly search for a returning patient or browse your directory alphabetically.