PGBAPGBA introducesintroduces north region north region providers to providers to myTRICARE claimsmyTRICARE 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 us secure, confidential questions to AskUs with the

myTRICARE 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 To become a member of myTRICARE claimsmyTRICARE claims Select Register now.

Three steps to gain secure accessThree steps to gain secure access1. Select Are you a TRICARE provider?

2. Read and accept the terms and conditions

3. Once you complete the registration process, you will be mailed a security key code to access myTRICARE claims

You are ready to sign into You are ready to sign into myTRICARE claimsmyTRICARE 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.

Secure welcome pageSecure welcome page

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

information

View of patient informationView 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

Other health insurance (OHI)

Deductible and out-of-pocket information

Claim statusClaim 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 Claim status - claims summaryclaims summary

* The above claim numbers are not actual claims

Select Details next to the claim you would like to see more information

Claim status Claim status - details details

Claim statusClaim status- patient payment information for this claim patient payment information for this claim

Claim status Claim status - list of services for claim list of services for claim

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

AskUs – no phone calls necessary!

• We’ll send you an email when there is new information in your mailbox

Email notification

MailboxMailbox 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 statusAuthorizations and referrals status View your patients’ authorizations and referrals online

Authorizations and referrals - summaryAuthorizations and referrals - summary

Authorizations and referrals - detailsAuthorizations and referrals - details

View remits - select locationView remits - select location

Remits – select date rangeRemits – select date range

Select remitSelect remit

Remits - view and printRemits - 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% ElectronicGo 100% Electronicwith EDI, EFT and ERA!with 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

dataMartdataMart

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 placeAll 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

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 Create your report according to your needsneeds

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 set up your dataMart report:

How to read your dataMart report for How to read your dataMart report for completed claimscompleted 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

View completed claims

How to read your dataMart report for How to read your dataMart report for in-process claimsin-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

View in-process claims

How to read your dataMart report for How to read your dataMart report for returned/transferred claimsreturned/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

View returned/transferred claims

View all claims

Download your dataMart report

Select the report you want to download

Example of dataMart Excel report

You can sort & filter within Excel

XPressClaimXPressClaim

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

Select the XPressClaim tab from the provider welcome page.

XPressClaim

Create your list or select the provider links

Build your provider list

Important to remember about your lists…

Select the location where services were provided

Select the doctor who provided care

Add a rendering provider to a location

You can add a new patient to your directory, quickly search for a

returning patient or browse your directory alphabetically.

Select the patient who received care

Confirm or update the patient’s information

Enter the services and charges for your claim

Submit Claim

View edits that you can fix

Immediate claim results

Print a summary receipt

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

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

XPressClaim accepted but not yet complete

Join myTRICARE Today!Join myTRICARE Today!

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