Pgba introduces north region providers to mytricare claims
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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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Pgba introduces north region providers to mytricare claims
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
To become a member of myTRICARE claims

  • Select Register now.


Three steps to gain secure access
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 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
Patient information

  • View patient real-time eligibility, OHI, cat cap and deductible information


View of patient 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
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


Claim status - details


Claim status- patient payment information for this claim


Claim status - list of services for claim


Askus no phone calls necessary
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
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
Authorizations and referrals status

  • View your patients’ authorizations and referrals online







Remits view and print
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 electronic with edi eft and era
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
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.


All the information you need in one place

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
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
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
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
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
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 claims

You can sort & filter within Excel


Xpressclaim
XPressClaim claims

  • 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 claims

Select the XPressClaim tab from the provider welcome page.








Select the patient who received care claims

You can add a new patient to your directory, quickly search for a returning patient or browse your directory alphabetically.




Submit Claim claims




Print a summary receipt claims

Provide your patients with receipts while they're still in your office


XPressClaim accepted but not yet complete claims

There are additional edits that PGBA will resolve, but we process this claim on a priority basis.


Join mytricare today
Join myTRICARE Today! claims

Thank you for touring myTRICARE claims for North Providers. By joining myTRICARE claims, you can use these online features to help manage your business.


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