PGBA, LLC (TRICARE Electronic Data Interchange) fax number

Fax destination details

Department

Electronic Data Interchange (EDI) Enrollment / ERA Enrollment

Purpose

Submit EFT and ERA enrollment forms for TRICARE West via PGBA; ERA enrollment forms are faxed to 803-264-9864 or mailed per the enrollment packet.

Form

EFT/ERA Enrollment Form — TRICARE West EFT/ERA Enrollment Packet

Address

P.O. Box 17150, Augusta, GA 30903

Voice phone

800-259-0264

Website

Visit organization website

Before you send

• Confirm that this exact department handles your document or request.
• Check the organization website or call its main line for the current fax number.
• Include a cover sheet and any case, member, claim, or form reference required.
• Keep the delivery confirmation with your submission records.

Complete the EFT and ERA enrollment forms per the packet. If enrolling in both TRICARE and VA CCN, submit to the TRICARE West addresses below. Online enrollment via Availity is available. For hard copies, fax 803-264-9864 to ERA enrollment or mail to the listed P.O. Box. EFT help desk contact is 800-259-0264.

Official form instructions are published as a downloadable file on the organization's website.