Today, Monday, December 30, 2024, EDIinsight® by Waystar notified us of important changes related to the T-5 TRICARE East Region:
- New TRICARE East regional contracts will go into effect soon: The Department of Defense (DoD) recently awarded the T-5 TRICARE East Region contract to Humana Government Business (HGB). Furthermore, PGBA will soon replace Wisconsin Physicians Service (WPS) Military Veterans Health and provide claims processing administrative services for the East region. Claims will need to be sent based on dates of service (DOS).
- Several states are moving from the East Region to the West Region: The following states will submit claims with DOS on or after 1/1/25, to TRICARE West Region (TRICW):
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- Arkansas
- Illinois
- Louisiana
- Oklahoma
- Texas
- Wisconsin
Action Taken by Waystar:
Waystar has created a new Tricare East Payer ID (99727) for claims with DOS beginning 1/1/2025. The existing payer, Tricare East (TREST), will also remain active. The enrollment team is working on re-enrolling each Waystar client for Tricare East remits in accordance with this new payer ID.
Waystar Action Required by Client:
Current East Region EDI claims for DOS prior to 01/01/25 should continue to be submitted to Payer ID TREST. WPS will continue to accept East Region claims with DOS prior to 01/01/25 until 04/30/25. For claims with dates of service 1/1/2025 and after, please submit those claims to Payer ID 99727.
Please update the new payer ID in your system accordingly and submit claims to the appropriate alias based on the information provided above. If you have any questions regarding this notice, please contact our Support Team.