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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.
Contact us
PGBA, LLC (PGBA) is the Health Net Federal Services, LLC HNFS claims processing partner in the TRICARE West Region. For additional information on TRICARE claims, visit .tricare-west.com or call 1-844-866-WEST (1-844-866-9378). For electronic claims filing assistance, call PGBA at 1-800-259-0264.
In most cases, your provider will file your medical claims for you. Youll receive an explanation of benefits detailing what TRICARE paid. Sometimes, youll need to file your own claims. If you do, send your claim form to TRICARE as soon as possible after you get care.
Contact the TRICARE EDI Help Desk for the West Region at 1-800-259-0264 or send an email to EDI.TRICARE@pgba.com.
Medical Claims Fill out the TRICARE Claim Form. Download the Patients Request for Medical Payment (DD Form 2642). Include a Copy of the Providers Bill. Attach a readable copy of the providers bill to the claim form, making sure it contains the following: Submit the Claim. Check the Status of Your Claims.
Claims must be filed within one year of the date of service or within one year of the date of an inpatient discharge or three years if overseas, but you are encouraged to send your claim form to TRICARE as soon as possible after you receive care.
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People also ask

Claims with supporting documentation, such as an Explanation of Benefits (EOB) or Certificate of Medical Necessity (CMN), can be sent electronically (recommended) or via paper submission.
WestHealth Net: 1-844-866-WEST (9378)
Fax the completed EFT Authorization Agreement to 1-844-787-9889.

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