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
• 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

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To become a member of myTRICARE claims

• Select Register now.

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Three steps to gain secure access

1. 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

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You are ready to sign into myTRICARE claims

• Youll 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.

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Secure welcome page
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Patient information

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

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View of patient information

• Real-time eligibility status
• Patients PCM (primary care manager) name
• Link to patients deductible and out-of-pocket
  information
• Link to patients OHI information

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Other health insurance (OHI)
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Deductible and out-of-pocket information
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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

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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
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Claim status - details
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Claim status- patient payment information for
this claim
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Claim status - list of services for claim
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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

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Email notification

• Well send you an email when there is new
  information in your mailbox

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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

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Authorizations and referrals status

• View your patients authorizations and referrals
  online

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Authorizations and referrals - summary
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Authorizations and referrals - details
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View remits - select location

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Remits select date range

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Select remit

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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

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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

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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, patients name, completed claims, etc.

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All the information you need in one place

• Patients name
• Patient account
• Claim
• Claim status
• Patients responsibility

• Billed amount
• Allowed amount
• Paid amount
• Check number
• Claim details

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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

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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
  (patients name, patients account number,
  completed date, etc.)

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How to set up your dataMart report
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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 Patients name
• You can scroll to find the specific name youre
  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

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View completed claims
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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 PGBAs system but have
  not yet completed processing.
• The left column displays the information the way
  you selected it. Example Patients account
  number
• You can scroll to find the specific name youre
  looking for in alphabetical order.
• The center section lists enough basic information
  about the claim to determine if this is one
  youre looking for (date of service, billed
  charge, etc.)
• See example on next slide

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View in-process claims
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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 Patients name
• You can scroll to find the specific name youre
  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

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View returned/transferred claims
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View all claims
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Download your dataMart report
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Select the report you want to download
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Example of dataMart Excel report
You can sort filter within Excel
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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

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XPressClaim
Select the XPressClaim tab from the provider
welcome page.
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Create your list or select the provider links
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Build your provider list
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Important to remember about your lists
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Select the location where services were provided
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Select the doctor who provided care
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Add a rendering provider to a location
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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.
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Confirm or update the patients information
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Enter the services and charges for your claim
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Submit Claim
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View edits that you can fix
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Immediate claim results
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Print a summary receipt
Provide your patients with receipts while they're
still in your office
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XPressClaim accepted but not yet complete
There are additional edits that PGBA will
resolve, but we process this claim on a priority
basis.
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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.