TRICARE East at a glance
| Legal name | Humana Government Business, Inc. (TRICARE East Region contractor) |
|---|---|
| Also known as | Humana Military, TRICARE East Region |
| Category | Government program |
| Parent organization | Defense Health Agency (contracted through Humana Government Business) |
| Claims payer ID | 99727 — registry reference; verify the member product, transaction and clearinghouse |
| Eligibility (270/271) payer ID | 99727 — registry reference; verify the member product, transaction and clearinghouse |
| ERA (835) payer ID | 99727 — registry reference; verify the member product, transaction and clearinghouse |
| NAIC company code | Not established in this registry |
| States covered | Alabama, Arkansas, Connecticut, Delaware, District of Columbia, Florida, Georgia, Illinois, Indiana, Iowa, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, New Hampshire, New Jersey, New York, North Carolina, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Carolina, Tennessee, Vermont, Virginia, West Virginia, Wisconsin |
| Provider resource entry point | https://www.humanamilitary.com/provider/claims |
| Provider phone | 1-800-444-5445 |
Always verify claims-routing details against the member ID card and the payer's current EDI companion guide before submission.
Timely filing & appeals for TRICARE East
Humana Military’s current claims page uses one year after service. Check inpatient, other-insurance and applicable TRICARE exceptions before calculating a deadline; do not mechanically substitute 365 days.
| Submission type | Window |
|---|---|
| Initial claim reference | One year; confirm claim-type start event |
| Out-of-network initial claim | Verify the member's plan and applicable out-of-network rules |
| Secondary / coordination of benefits | Verify the allowed window and start event; a primary EOB does not automatically restart filing |
| Corrected claim | Verify correction instructions; do not substitute an appeal deadline |
| Reconsideration / appeal | Use the applicable denial or decision notice and the process below |
Reconsideration and appeal routes
- ReconsiderationFile within 90 days
Written reconsideration request submitted within 90 days of the initial determination per TRICARE Policy Manual.
- Formal ReviewFile within 60 days
Formal review by the TRICARE Area Office following an unfavorable reconsideration.
- HearingFile within 60 days
Hearing before a DHA-appointed hearing officer (claims ≥ the TRICARE hearing threshold).
Source: TRICARE East provider policy. Always confirm before disputing a TFL denial — payer policies are versioned and product-specific.
Prior authorization with TRICARE East
Decision deadlines depend on the product, service and urgency. CMS-0057-F generally starts its decision-timeframe requirements in 2026 for Medicare Advantage, Medicaid and CHIP payers subject to the rule: seven calendar days for standard requests and 72 hours for expedited requests. Those requirements exclude drug authorizations and QHP issuers on the federally facilitated exchanges. Other plans, state rules and permitted extensions can differ. Check the applicable policy; a decision deadline is not a guarantee of approval.
CMS-0057-F decision-timeframe requirements and exclusions
Verify TRICARE East electronic claims (837), eligibility (270/271), remittance (835) and authorization (278) separately for the member product and clearinghouse. Registry flags and routing references are not current transaction-complete approval. Confirm the companion guide, enrollment and applicable source findings below. A blank or unverified field does not establish that the transaction is unavailable. Authorization requirements and submission channels depend on the product, service and delegated reviewer. Verify the applicable policy before scheduling; a portal listing is not proof of X12 278 connectivity.
This registry does not provide a current prior-authorization code list for TRICARE East. Start with the provider resources or the policy documents below, then confirm the applicable product, service and effective date. A resource link does not establish that a live code-lookup tool is available.
Top denial reasons for TRICARE East
Per-payer denial benchmarks publish here once the QuickIntell anonymized ETL pipeline ingests sufficient TRICARE East volume. Until then, see the broader CARC reference for industry-wide remediation guides.
Electronic claims, eligibility & ERA
| Transaction | Registry indication — not verification | Routing reference |
|---|---|---|
| 837P / 837I claims | Listed in registry; verify current scope | 99727 — registry reference; verify the member product, transaction and clearinghouse |
| 270 / 271 eligibility | Listed in registry; verify current scope | 99727 — registry reference; verify the member product, transaction and clearinghouse |
| 278 prior authorization | Listed in registry; verify current scope | Verify X12 278 routing separately |
| 835 ERA | Verify support and enrollment separately | 99727 — registry reference; verify the member product, transaction and clearinghouse |
Payer IDs vary by clearinghouse — confirm against your clearinghouse payer list (Availity, Change Healthcare/Optum, Waystar) before configuring submitter routing.
What revenue cycle teams should verify before submitting claims
- Humana Military specifies 99727 for X12 837 claims, including the ISA08, GS03 and NM109 routing fields. This comparison does not establish that the same identifier applies to eligibility or ERA enrollment.
- Use the current TRICARE East claims instructions and verify the applicable inpatient, other-insurance and contract exceptions before calculating a filing date.
Source checks and remaining limits
The latest partial comparison is dated . Retained earlier findings keep their original dates below. This is a partial source check, not a whole-page, clinical or legal review. It does not refresh the legacy review date above.
payer_ids.claims, electronic_claims_supported, portal_url, timely_filing_days, filing_rule
Source comparison: 2026-09-18
99727 is specifically X12 837 claims; one year after service is the cited unit. EFT/ERA requires enrollment; source does not certify 99727 for all other transactions. Source locator: TRICARE East payer ID; Claim processing; Electronic claims.
Primary source for payer_ids.claims, electronic_claims_supported, portal_url, timely_filing_days, filing_rule
Not checked in this pass: All fields outside these bounded findings, including exact legal entity/NAIC, current enrollment and geography; Product-complete initial, corrected, secondary and appeal rules, agreements, exceptions and effective dates; Every claims, eligibility, ERA and authorization transaction identifier; portal access is not capability certification; Current clinical criteria and prior-authorization code samples; QuickIntell integrations/outcomes and historical DataForSEO demand; Accountable whole-record editorial approval; no last_reviewed date was advanced.
Sources used for this guide
State coverage
TRICARE East operates in the following states. Each link opens state-level Medicaid program details, dominant commercial payers, and state-specific RCM regulations.
- Alabama
- Arkansas
- Connecticut
- Delaware
- District of Columbia
- Florida
- Georgia
- Illinois
- Indiana
- Iowa
- Kentucky
- Louisiana
- Maine
- Maryland
- Massachusetts
- Michigan
- Minnesota
- Mississippi
- Missouri
- New Hampshire
- New Jersey
- New York
- North Carolina
- Ohio
- Oklahoma
- Pennsylvania
- Rhode Island
- South Carolina
- Tennessee
- Vermont
- Virginia
- West Virginia
- Wisconsin
Evaluate QuickIntell workflow fit for TRICARE East
These module references are evaluation starting points, not evidence of a validated connection, supported transaction or customer deployment. Confirm the actual member plan, data access and product scope first.
- QuickRCM
Evaluate claim preparation, follow-up and denial worklists for TRICARE East; verify the actual plan rules and available connections before implementation.
- QuickAuth
Assess authorization-packet and status workflows for TRICARE East; confirm product, service, delegated reviewer and permitted submission channels.
- QuickERA
Verify the actual 835 files, posting exceptions and reconciliation requirements for TRICARE East before evaluating automation. An ERA identifier alone does not establish supported ingestion or posting.
Frequently asked questions about TRICARE East
Where is the TRICARE East provider portal?
Use https://www.humanamilitary.com/provider/claims as a starting point for TRICARE East provider resources. This link may open a directory or contact page rather than a transaction portal. Select the applicable product and administrator, then verify the available functions, enrollment and access requirements. QuickIntell is not the official payer portal.
What is the timely filing limit for TRICARE East?
Humana Military’s current claims page uses one year after service. Check inpatient, other-insurance and applicable TRICARE exceptions before calculating a deadline; do not mechanically substitute 365 days.
What is the TRICARE East payer ID?
Claims: 99727 — registry reference; verify the member product, transaction and clearinghouse. Eligibility (270/271): 99727 — registry reference; verify the member product, transaction and clearinghouse. ERA (835): 99727 — registry reference; verify the member product, transaction and clearinghouse. Do not substitute a claims ID for an unverified transaction ID. Check current source findings and the member ID card before submitting.
Does TRICARE East accept electronic claims?
Verify TRICARE East electronic claims (837), eligibility (270/271), remittance (835) and authorization (278) separately for the member product and clearinghouse. Registry flags and routing references are not current transaction-complete approval. Confirm the companion guide, enrollment and applicable source findings below. A blank or unverified field does not establish that the transaction is unavailable.
How do I appeal a TRICARE East denial?
Identify the product, state and reason for the decision before choosing a TRICARE East dispute route. The listed starting route is Reconsideration (File within 90 days). Written reconsideration request submitted within 90 days of the initial determination per TRICARE Policy Manual. Verify the controlling notice and exceptions; reconsideration, appeal and external review are not always a mandatory sequence.
How long do TRICARE East prior authorization approvals take?
Decision deadlines depend on the product, service and urgency. CMS-0057-F generally starts its decision-timeframe requirements in 2026 for Medicare Advantage, Medicaid and CHIP payers subject to the rule: seven calendar days for standard requests and 72 hours for expedited requests. Those requirements exclude drug authorizations and QHP issuers on the federally facilitated exchanges. Other plans, state rules and permitted extensions can differ. Check the applicable policy; a decision deadline is not a guarantee of approval.
What is the TRICARE East provider phone number?
This registry lists 1-800-444-5445 as a contact reference for TRICARE East. Confirm the number and service scope against the member ID card and current product-specific directory; claims, eligibility and authorization inquiries may use different teams.
For revenue-cycle teams
Connect payer lookups to your revenue-cycle workflow
Do staff repeatedly move between payer references, eligibility checks, claim status and remittance follow-up?
- Keep this payer's official reference available to the team.
- Identify one repeated administrative task and measure its handling time.
- Evaluate the required access, exceptions and reviewer handoff before expanding automation.
TRICARE East is an operational reference. Payer decisions remain with the payer. Confirm plan coverage, system access and supported actions during a scoped evaluation.
Download the illustrative workflow worksheet (PDF) · Explore the AI RCM evaluation toolkit · Model the workload and costs
Automate workflows around TRICARE East requirements
Connect eligibility, prior authorization, pre-submission claim checks, and remittance routing in one governed workflow. Payer and plan configuration is confirmed during implementation.
Disclaimer
This page is operational reference for medical-billing professionals. It is not legal, clinical, or contractual advice. Payer policies change without notice — always verify against TRICARE East's current published documents before submission. CPT® is a registered trademark of the American Medical Association.