TRICARE

TRICARE is insurance for Military personnel and their immediate families. This insurance has been extended to NATO members and to Reserves whom have been activated (called to active duty).

TRICARE is broken into two regions: West and East

• West — Health Net Federal Services
• East — Humana Military

There are two payors for TRICARE: WPS and PGBA.

• WPS — Wisconsin Physicians Service processed all of Humana Military claims.
• PGBA — Palmetto GBA processes all of Health Net Federal Services claims.

ChampVA

The Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) is a health benefits program in which the Department of Veterans Affairs (VA) shares the cost of certain health care services and supplies with eligible beneficiaries.

RUG Table

The Resource Utilization Group (RUG) Table data can be viewed through the TRICARE Provider Profile page.

If the Metropolitan Statistical Area (MSA) has the 99XX format, the facility is considered a rural facility. Otherwise, it is considered an urban facility.

How To Topics

Refer to the menu on the left for instructions on managing provider profiles, using calculators, and utilizing reimbursement tools (nodes).

The following topics provide step-by-step instructions for managing provider profiles, using calculators, and utilizing reimbursement tools (nodes).

• View the TRICARE Provider Profile
• Work with TRICARE Calculators
• TRICARE: Reimbursement Tool