Humana military is the proud administrator of the tricare south contract. Although it appears to be an insurance program, it is actually a benefit program. Tricare for life tfl is a medical benefit program designed to pay for medical expenses for active duty military personnel and their families, and also for retired military personnel and their families. Beginning spring 2016, tricare reimbursement rates for aba providers under the demonstration will change to become more consistent with national prevailing rates. Regional contractors administer the tricare medical benefit in each tricare region. Tricare manuals display to15 chap 5 sect 1 network. We are providing this information so that you may be aware of what tricare is currently allowed to pay for various medical procedures or services before you see a provider.
Tricare south region electronic data interchange po box 17150 augusta, ga 30903 fax. At a glance tricare is the department of defenses worldwide health care program available to eligible beneficiaries from any of the seven uniformed servicesthe u. Our objective was to determine whether the dod appropriately paid for autism services in. The west region is administered by health net federal services. Territory, call 18667730404 or visit if youre using the us family health plan, call 180074usfhp 18007487347 or visit. Wisconsin physicians service wps will be the tricare claims processor for the new east region and humana behavioral health will be the new. Health net federal services is the managed care support contractor for the tricare north region. Tricare prime, the dod sponsored military managed health care program, provides enhanced. Currently, there are three tricare regions in the u. Department of defense announced that the east region. Latin america and canada areaclick to closecentral and south america, the caribbean basin, canada, puerto rico and the virgin islands. Tricare styled tricare, formerly known as the civilian health and medical program of the uniformed services champus, is a health care program of the united states department of defense military health system. Customer service representatives are available at that number between 8 a. Civilian provider acceptance of, and beneficiary access to, tricare standard and extra.
The most recent contract process began in july 2009, with the north region contract going to aetna, the south. Apta has advocated and will continue to advocate for policy changes to allow ptas to provide reimbursable services under tricare. It acts as a bridge between military health benefits and your new civilian health plan. Unlike tricare prime options, enrollment is not required, meaning there are no forms to fill out and no annual enrollment fees to pay. The handbook must be read in light of governing statutes and. The manuals will apply to the tdefic contract upon direction of the contracting officer.
We are currently experiencing technical difficulties with access to the tricare for life summary explanations of benefits. Topics include authorizations and referrals, claims, benefits, eligibility, mental health care, and active dutynational guard and reserve. Eastern time provider locator services are available 24 hours a day, seven days a week. This tricare west region provider handbook will assist you in delivering tricare benefits and services. Tricare is the dods managed health care program for active duty service members. To use tricare standard, seek care from any tricareauthorized provider. Tricare provider resources chart humana military pgba electronic data interchange edi help desk tricare south region data management dept.
Tricare program manuals 2015 edition t 2017 these manuals are applicable to the east and west regional managed care support contracts mcscs awarded on or after 07212016. To02 chap 20 sect 11 tricare south region united states coast guard. Claims for beneficiaries using medicare and tricare for life. When we work together, we protect those who keep us protected. Chapter 2 of the 2015 version of the manual includes guidance and. The path those companies took to running the tricare regions was anything but smooth. With tricare standard and tricare extra, you manage your own health care and have the freedom to seek. Under t2017, dha reduced the number of tricare regions by merging.
These charges are the maximum amounts tricare is allowed to pay for each procedure or service and are tied by law to medicares allowable charges. East region click to close under the new regional contracts, the east region is a merger of the north and south regions and includes. Mhs and the defense health agency dha tricare manuals. The tricare program is administered by 2 separate contractors in 2 different regions. To02 chap 4 toc provider certification and credentialing tricare operations manual tom. The national defense authorization act of 2017, signed on december 12, included a provision adding ptas. Continued health care benefit program chcbp chcbp is a premiumbased plan that offers temporary transitional health coverage for 18 to 36 months after tricare eligibility ends. The johns hopkins us family health plan provider manual. This tricare beneficiary handbook will help you learn about your tricare benefits and services. Additionally, tricare clarified that any counselor meeting the transition criteria before january 1, 2017, could apply at any time under those standards including after the transition period closes.
Tricare provider number with suffix national provider. Tricare prime health care plans are available in certain areas across the world. Another tricarerelated matter of importance to apta members is the agencys recent announcement that in 2017 it will consolidate its regions from 3 to 2. This includes baltic states, ukraine, georgia, kazakhstan, kyrgyzstan and uzbekistan. Evaluation of the tricare program fiscal year 2018. Alabama, arkansas, connecticut, delaware, the district of columbia, florida, georgia, illinois, indiana, iowa. It is a benefit offered to persons serving in the military. Log in to selfservice to submit claims or check status. Audit of tricare payments for health care services and.
The audit was requested by the director, tricare health plan. Oregon, south dakota, texas areas of western texas only. S armed forces military personnel, military retirees, and their dependents, including some members of the. In order to determine whether you are eligible for receiving tricare prime coverage, you can use your zip code to see if the area you reside in is a prime service area. Prior authorization requirements for e0784, k0553 and k0554. Log in to submit or update a referralauthorization. This handbook highlights covered services, customer service options, and other important benefit information. Tricare merges regions effective january 2018 national. Humana military, currently the south region mcsc, was awarded the new east region contract set to start january 1, 2018. Our regional and other contractor partners provide health care services for each tricare health plan, pharmacy and dental benefits. The defense health agency improperly paid for autism. Select your new tricare region as of january 1, 2018, the contractor for the tricare west region is healthnet federal services and the contractor for the tricare east region is humana militarytricare west region is healthnet federal services and the contractor for the tricare east region is humana military. Tricare regulations are available on the defense health agency dha website at.
This manual details our referral process, quality standards, credentialing and reimbursement process. For a complete list of current premiums and cost shares. If there are any discrepancies between the tricare west region provider handbook and tricare manuals manuals, the manuals take precedence. The new east region merges the current north and south regions to make a new singular region. Medicare, and tricare allow you to bill the patient for 115% of the allowable. This benefit is not retroactive and any services rendered prior to. Previously, the ifr was scheduled to end december 31, 2014, but the final rule extends the transition period for two years, until january 1, 2017. The tricare west region provider quick reference charts provide quick access to key information about tricare in a printable format. European and african continents, all middle eastern countries, pakistan, russia and several former soviet republics. Tricare south region contractor humana military healthcare services,inc. On january 1, 2020, tricare began covering 3d mammograms.
Global 3m19 medical policy and technology assessment committee prior authorization requirement updates. The program was implemented in this region in 1998 to expand access to health care and. Assistance with general information, benefits, claims, eligibility, authorizations and provider inquiries. Thank you for choosing electronic submission for your healthcare claims. Services to selected companies in the tricare south region. Tricare provider types tricare defines a provider as a person, business, or institution that provides health care. If you are unable to access your explanation of benefits, please contact us at 18667730404 monday through friday or leave a message on the message center on this website. The contractor that provides benefits in the region is humana. Tricare program manuals 2015 edition t 2017 tricare operations manual 6010. August 2015 important information tricare web site.
Contracted tricare providers are obligated to abide by the rules, tricare dental options. Dod proposes consolidating tricare regions into two. Authorization act of 2017 ndaa fy 2017 introduced a split. There are some changes to the tricare program for 2017.
The network shall meet the standards in paragraph 3. Tricare young adult tya premium rates are established annually on a calendar year cy basis in accordance with title 10, united states code, section 111ob and title 32, code of federal regulations, part 199. Upon direction of the contracting officer co, all or portions of these manuals may also apply to the tqmc, tcars, top, tpharm, tdp, and tdefic. Tya monthly premiums for cy 2015 shall be the rates listed in this document. Medicare new specialty pharmacy medical step therapy requirements effective january 17, 2020.
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