Mailing Addresses/Fax Numbers

TRICARE West Claims Submission
Health Net Federal Services, LLC
c/o PGBA, LLC/TRICARE
P.O. Box 202112
Florence, SC 29502-2112
Fax: 1-844-869-2504

Routine Correspondence
Health Net Federal Services, LLC
c/o PGBA, LLC/TRICARE
P.O. Box 202100
Florence, SC 29502-2102
Fax: 1-844-869-2812

Claims Adjustments/Allowable Charge Review
Health Net Federal Services, LLC
c/o PGBA, LLC/TRICARE
Allowable Charge Review
P.O. Box 202100
Florence, SC 29502-2100
Fax: 1-844-869-2812

Claim Recoupments/Refunds
Health Net Federal Services, LLC
c/o PGBA, LLC TRICARE Refunds
Attention: TRICARE West Region
P.O. Box 202111
Florence, SC 29502-2111

Good Faith Payment Reviews
Health Net Federal Services, LLC
TRICARE West – Priority Correspondence
P.O. Box 202101
Florence, SC 29502-2101
Fax: 1-844-869-2811

Other Health Insurance Questionnaire
TRICARE West - OHI Questionnaire
P.O. Box 202102
Florence, SC 29502-2102
Fax: 1-844-730-1372

Third Party Liabilty (TPL) Correspondence
TRICARE West - TPL Correspondence
P.O. Box 202103
Florence, SC 29502-2103
Fax: 1-844-869-2813

Electronic Funds Transfer (EFT) 
TRICARE West Region
EFT/ERA Enrollment
P.O. Box 202109
Florence, SC 29502-2109
Fax: 1-844-730-1369

Electronic Remittance Advice (ERA)
PGBA, LLC/TRICARE Electronic Data Interchange
P.O. Box 17150
Augusta, GA 30903
Fax: (803) 264-9864

TRICARE Pharmacy Claims 
Express Scripts
P.O. Box 52132
Phoenix, AZ 85072

Out-of-Region Claims
TRICARE East Region Claims
P.O. Box 7981
Madison, WI 53707-7981

TRICARE Prime, TRICARE Prime Remote/TRICARE Prime Remote for Active Duty Family Members, TRICARE Select (enrollment forms)
Health Net Federal Services, LLC
P.O. Box 8458
Virginia Beach, VA 23450-8458
Fax: 1-844-388-8282

TRICARE Reserve Select/TRICARE Retired Reserve/TRICARE Young Adult (enrollment forms)
Health Net Federal Services, LLC
P.O. Box 9028
Virginia Beach, VA 23450-9028
Fax: 1-844-388-8282

Enrollment Payment Method Changes
Health Net Federal Services, LLC
P.O. Box 8608
Virginia Beach, VA 23450-8608
Fax: 1-844-785-2604

Network Participation Agreement Packet
Health Net Federal Services, LLC/TRICARE
P.O. Box 9410
Virginia Beach, VA 23450-9410
Fax: 1-844-836-5818

Provider Information Form
Health Net Federal Services, LLC/TRICARE
Fax only: 1-844-224-0381

Legal Notices 
Health Net Federal Services, LLC
P.O. Box 9410
Virginia Beach, VA 23450-9410
Attn: Provider Network Management
Fax: 1-844-836-5818

Non-Network Provider Updates 
TRICARE West Provider Data Management
P.O. Box 202106
Florence, SC 29502-2106
Fax: 1-844-730-1373