Reminder
The more information you provide about your OHI, the more accurate and timely response to your claim. Please complete the OHI questionnaire and return to us at TRICAREOHIUpdate@humana.com or fax to (608) 221-7536.
By law, TRICARE pays after all OHI, except for:
This means your OHI processes your claim first. Then, you or your provider files your claim with TRICARE. Your provider MUST be TRICARE-certified for TRICARE to pay up to the TRICARE Maximum Allowable Charge (TMAC) on covered services. If TRICARE receives your claim before your OHI processes it, TRICARE will deny it. If TRICARE pays first and later discovers you had OHI, TRICARE will take back any payments made and will reprocess the claim after your OHI has processed it.
When you have OHI with pharmacy benefits, your OHI pays first and TRICARE pays second. You can avoid higher costs by getting your prescriptions filled at a TRICARE network pharmacy that is also in your other plan's network.
To avoid delays or problems when processing your prescriptions claims, tell Express Scripts you have OHI. Likewise, if you no longer have OHI with pharmacy benefits, you must tell Express Scripts.
If you are adding, removing or changing OHI, you will need to notify TRICARE and all assigned providers to prevent future claims issues. If you only contact TRICARE to remove your OHI and don’t notify your provider, your provider will submit a claim with OHI which will cause your OHI information to automatically be added back to your account when the claim processes and the claim will deny for OHI.
Notifying both TRICARE and your provider of any OHI updates prior to any scheduled appointment should prevent claim delay or denial due to OHI.
You cannot use OHI, TRICARE is your only coverage.
TRICARE will pay after Medicare and your OHI for TRICARE-covered services. See which plan - Medicare or your OHI - pays first.
If you have a newborn and the birthing parent has OHI, your OHI provider may automatically extend the newborn 30-days of coverage. Be sure to notify Defense Enrollment Eligibility Reporting System (DEERS).
Confirm with your parent who is the plan sponsor if they have OHI before calling customer service to change your OHI status. This will avoid delays and denials in processing of claims.
OHI is any insurance other than TRICARE. It can be through your employer or a private insurance program. By law, TRICARE pays after all OHI, except for:
You either mentioned during your enrollment process that you have OHI, or a provider reported that you may have OHI.
Yes. Even if it was for one month, OHI should be reported so that any claims during that period can be paid correctly.
No. You need to contact Express Scripts at (877) 363-1303 separately to add, delete or update your OHI information.
When your insurance changes, notify us and any providers who have submitted claims on your behalf recently. Tell them that you have had a change in your insurance information. This will help your claims process more quickly and reduce the possibility of denials.