Can I Refund Tricare If Billed in Error?

According to the American Medical Association, auditing your medical billing system can prevent erroneous claims; it can save money and effort in the long run. If a mistake has already occurred, billing errors with TRICARE can be corrected.

Contact

• TRICARE claims are processed by PGBA and not by Humana or TRICARE directly. Contact PGBA at 1-800-403-3950 with billing errors. Calling PGBA will allow you to speak to a claims representative about your specific erroneous bill.

Significance

• Billing in error can be interpreted as fraud and abuse if you, the provider, do not correct the error. TRICARE specifically includes unintentional billing errors in its definition of abuse.

Time Frame

• Changes to correct billing errors to your provider claim amounts or billing codes must be made within 90 days. You can change your claim by accessing your electronic claim or calling PGBA.

Prevention

• TRICARE uses an automated system to check claims, ensuring that it is consistent for the provider and patient. This system rejects some erroneous billing. You will receive a rejection if the system flags your claim, and you wouldn't need to worry about refunding TRICARE, if your claim is rejected.