Get the free tricare pgba era enrollment form

Print Form TRI CARE PBA, LLC Government Programs Electronic Data Interchange Department PO Box 202007, Florence, South Carolina 29502-2007 Phone 1-800-325-5920, Option #2 Dear Provider: Thank you

How to fill out tricare pgba era enrollment

How to fill out tricare pgba era enrollment:

1. Visit the official tricare pgba era enrollment website.
2. Click on the enrollment form link to download the form.
3. Fill out the form with accurate and up-to-date information.
4. Provide your personal details, such as name, address, phone number, and email.
5. Enter your eligibility information, including your sponsor's information if applicable.
6. Indicate the type of coverage you are seeking and the effective date.
7. If you have dependents, include their information and ensure all necessary fields are completed.
8. Review the filled form for any errors or missing information.
9. Sign and date the form.
10. Submit the form as instructed on the website or by mail.

Who needs tricare pgba era enrollment:

1. Members of the military, including active duty, retired, and reserve members.
2. Eligible family members of military service members.
3. Certain beneficiaries, such as Survivors of deceased military members and Medal of Honor recipients.
4. Individuals who wish to apply for or make changes to their tricare pgba era coverage.

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What is tricare pgba era enrollment?

Tricare PGBA ERA enrollment is the process by which healthcare providers enroll to receive electronic remittance advice (ERA) from the Tricare program administered by the PGBA (Pilot Government Benefit Administrators).

Who is required to file tricare pgba era enrollment?

All healthcare providers who wish to receive electronic remittance advice (ERA) from the Tricare program administered by the PGBA are required to file Tricare PGBA ERA enrollment.

How to fill out tricare pgba era enrollment?

To fill out Tricare PGBA ERA enrollment, healthcare providers need to visit the Tricare website and complete the online enrollment form, providing all necessary information and documentation as requested.

What is the purpose of tricare pgba era enrollment?

The purpose of Tricare PGBA ERA enrollment is to enable healthcare providers to receive electronic remittance advice (ERA) from the Tricare program, streamlining the payment process and improving efficiency.

What information must be reported on tricare pgba era enrollment?

The specific information that must be reported on Tricare PGBA ERA enrollment includes the healthcare provider's contact details, practice information, National Provider Identifier (NPI), banking information for electronic funds transfer, and any other requested documentation.