PGBA introduces north region providers to myTRICARE claims

1. 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

2. To become a member of myTRICARE claims • Select Register now.

3. 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

4. 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.

5. Secure welcome page

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

7. 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

8. Other health insurance (OHI)

9. Deductible and out-of-pocket information

10. 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

11. 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

12. Claim status - details

13. Claim status- patient payment information for this claim

14. Claim status - list of services for claim

15. 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

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

17. 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

18. Authorizations and referrals status • View your patients’ authorizations and referrals online

19. Authorizations and referrals - summary

20. Authorizations and referrals - details

21. View remits - select location

22. Remits – select date range

23. Select remit

24. 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

25. 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

26. 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.

27. 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

28. 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

29. 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.)

30. How to set up your dataMart report:

31. 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

32. View completed claims

33. 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

34. View in-process claims

35. 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

36. View returned/transferred claims

37. View all claims

38. Download your dataMart report

39. Select the report you want to download

40. Example of dataMart Excel report You can sort & filter within Excel

41. 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

42. XPressClaim Select the XPressClaim tab from the provider welcome page.

43. Create your list or select the provider links

44. Build your provider list

45. Important to remember about your lists…

46. Select the location where services were provided

47. Select the doctor who provided care

48. Add a rendering provider to a location

49. 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.

50. Confirm or update the patient’s information