Timeliness and Electronic Funds Transfer/Electronic Remittance Advice

Timeliness Requirements

Providers must submit all claims for TRICARE covered services to PGBA for claims processing in accordance with the TriWest TRICARE Provider Handbook. These claims should be submitted:

  • No later than one year (365 days) after services are provided.
  • One year from the date of discharge for an inpatient admission for facility charges billed by the facility or an ancillary provider participating in the inpatient care.

To ensure timely submission and payment, TriWest strongly recommends filing claims within 30 days of the date of service.

The claim should be submitted to PGBA within 90 calendar days from the date of the Other Health Insurance (OHI) adjudication.

Follow best practices when submitting claims:

  • Verify all information is complete and accurate before submitting a claim.
  • Provide complete documentation with your claim. Attach all necessary documents, and ensure they meet the formatting requirements.
  • Submit claims promptly after the service was rendered.
  • Monitor your claims status regularly.

Electronic Funds Transfer/Electronic Remittance Advice

Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA) allow healthcare providers to securely receive payments and remittance information from TriWest.

Electronic Funds Transfer

EFT allows healthcare providers to receive direct deposits into designated bank accounts. EFT also eliminates the need for paper checks, reduces administrative overhead, and enables faster access to funds for providers.

To enroll electronically in EFT with TriWest, please follow the EFT/ERA enrollment instructions.

Once enrolled, TriWest will deposit payments directly into the designated bank account.

If you are unable to enroll electronically, please complete and submit the paper form in the PGBA EFT/ERA Enrollment Package to the fax number or address on the form.

Electronic Remittance Advice

ERA provides healthcare providers with an electronic summary of payments and adjustments made on claims submitted to TriWest. ERA simplifies the reconciliation process by detailing payment information, including dates, amounts, and reasons for adjustments.

To enroll electronically in ERA from TriWest, please follow the EFT/ERA enrollment instructions.

If you are unable to enroll electronically, please complete and submit the paper form in the PGBA EFT/ERA Enrollment Package to the fax number or address on the form.