Claims Conversion Process Updates

New Claims Processor, New Payer ID Effective June 9

Effective June 9, 2021, TriWest will subcontract all health care claims processing and payment to PGBA. This includes claims for both Patient-Centered Community Care (PC3) and Community Care Network (CCN) providers.

TriWest VA Claims must be sent only to PGBA. WPS MVH will no longer accept new claims. Any paper claims received by WPS MVH after June 8 will be forwarded to PGBA via USPS for a limited period of time. Claims submitted electronically using the previous Payer ID will be rejected.

There is no change to the claims processing for dental or pharmacy claims.

Important Dates for Our Provider Community

CCN Providers

June 8 – Last day claims can be received at WPS MVH.

June 9 – Submit to PGBA only.

Region 4 (AZ, CA, CO, HI, ID, MT, NM, NV, OR, TX, UT, WA, WY) – Submit to PGBA starting June 9, 2021.

Region 5 (Alaska) – Kodiak, Alaska providers submit to PGBA now.

PC3 Providers

June 8 – Last day claims can be received at WPS MVH.

June 9 – Submit to PGBA only.

U.S. Pacific Island Territories (America Samoa, Guam, N. Marianas) and Alaska – Submit to PGBA starting June 9, 2021.

Electronic Claims (EDI/EFT/ERA) Set Up

Start the process now to establish electronic claims processing through PGBA.

Go to Availity.com and login. Navigate to TriWest’s Payer Space. Select the Resources tab. Find “PGBA EFT/ERA Enrollment Package” and/or “PGBA EDI Provider Trading Partner Agreement” for instructions and guidelines.

Please note that PGBA will not begin processing enrollment applications until late May.

Need more details? Read this Q&A based on the questions we’ve received from providers.

PGBA Claims Submission Details

Payer ID
TWVACCN

Address to Submit Paper Claims to PGBA
TriWest VA CCN Claims
PO Box 108851
Florence, SC 29502-8851

Sign Up for a PGBA Claims Webinar to Learn More

Login to Availity.com. Go to TriWest’s Payer Space. Select the TriWest Learning Center. Click on Sessions. Register for the “PGBA Claims” webinar.

Questions?

You can contact TriWest Provider Services at providerservices@triwest.com or call TriWest’s toll-free CCN Contact Center at 877-CCN-TRIW (877-226-8749).

Updated: 6/8/2021 2:14:27 PM