Important Update: Changes to TRICARE East Region Claims Processing 

Ashley Fernando, RCM Operations Manager, Experity

What is TRICARE?
TRICARE is the health care program for uniformed service members, retirees, and their families around the world. It provides comprehensive coverage, including health plans, special programs, prescriptions, and dental plans. TRICARE is managed by the Defense Health Agency (DHA) under the U.S. Department of Defense and is divided into regions, including TRICARE East and TRICARE West, with different contractors handling claims and services for each. 

Effective May 1, 2025, the payer listed as TRICARE East Region DOS before Jan. 1, 2025 (CPIDs 1253, 4585, Payer ID: TREST) will no longer be available through Optum for claims processing due to the termination of their contract with WPS. To ensure timely processing, all claims with this payer must be submitted to Optum no later than April 30, 2025, by 8:00 p.m. CT. WPS will continue to generate payments and remittance advices through July 1, 2025, or earlier if all claims are fully adjudicated. Optum will continue to process remittances from WPS during the run-out period. 

Beginning May 1, 2025, all claims for TRICARE East Region, regardless of date of service, must be submitted using CPIDs 2872 and 5979 with the new Payer ID: 99727. Claims submission does not require new payer enrollment if a PGBA Electronic Data Interchange (EDI) Provider Trading Partner Agreement is already on file. If not, providers must complete the Optum enrollment process before submitting claims. For electronic remittance, enrollment is required. Providers already receiving remittance via Optum for the updated CPIDs do not need to re-enroll; all others must submit a new enrollment form. Please update your systems accordingly. To access the new enrollment forms, visit Enrollment Central.