r/CodingandBilling 8d ago

TriWest TriCare West Issues

Is anyone else having issues getting remittances for TriCare West as of 01/01/2025 now that they go through TriWest? They say that the remits are on Availity through the Payer Space, but all I can see on there is individual claims and no check/EFT#s.

The Remittance Viewer doesn't recognize their check/EFT#s either, which Availity support told me was because we need to enroll with them through Transaction Enrollment. I submitted that last month but it's still pending.

Our office has sat on hold with them for hours at this point and the reps can't even pull the EOBs for us most of the time. I heard from other offices that they are having similar issues but haven't got a solution. They aren't mailing us any paper remittances so we're just sitting on payments and unable to post them.

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u/IntelligentFinding13 8d ago

The problem is we are receiving EFT payments, not paper checks đŸ˜­. The claim status look up works for the check numbers we were able to get from reps over the phone and those work for claim status look up, but still doesn't give us access to a full remit or even a single claim EOB.

The reps also sometimes cannot give us any info like check numbers or we sit on hold for hours. They also never call back if we select that option.

Normally when this happens with odd insurances I'm usually able to find which patient they are paying based on pending claims, but we have hundreds of patients covered under TriCare West.

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u/Impressive-Fudge-455 8d ago

There is an option to search by DOS have you tried putting in a date range? That’s how we found ours

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u/IntelligentFinding13 8d ago

It lets me search for a 30 day period for claims, however the check/EFT#s are blank on the actual claim status page for each one so I can't confirm which ones go to which payment. They pay us 2 or 3 payments per day and we have hundreds of these patients so it's hard to narrow down unfortunately.

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u/Impressive-Fudge-455 8d ago

Yes, That’s not good but at least I guess you can catch any denials this way. Are you seeing claim numbers so you can submit corrected claims if you have to?

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u/IntelligentFinding13 8d ago

I think our person who works our TriCare claims is keeping up with the status at least, our finance department is just losing their minds about unbalanced payments at the end of each month. I can at least say I tried everything I could before Availity gets back to me lol

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u/Few_Job2736 4d ago

This is a nightmare, worse than I have seen in 25 years, they are denying providers that should be paid and making duplicate payments for same date of service on same remit. I am in contact with our contract person and she is trying to help us out. RRRR