Clinical quality ratings and cost-efficiency ratings are displayed on the provider results page of our Find care tool.
The main focus of these ratings is transparency. These ratings should be used only as information when choosing care. TRICARE beneficiaries are encouraged to consider all relevant information and to consult with their treating provider.
Users will not see anything related to ratings if a provider specialty or geography is out of scope. If a specialty and/or geography are in scope, but the data is not statistically credible or there is not enough data to complete a comprehensive evaluation, "Not enough information to measure" will be displayed.
A provider's rating is not affected by TRICARE beneficiary feedback.
Efficiency, also described as cost-efficiency, measures a provider's total cost for treatment that TRICARE beneficiaries received compared to treatment provided by other providers in the same specialty type and geography. Treatment could include services such as doctor's visits, lab test, related medication, surgeries done in hospitals, etc.
Effectiveness, also described as clinical quality, measures a provider's adherence to evidence-based medicine when treating TRICARE beneficiaries as compared to a peer group in the same specialty type and geography.
Provider's ratings will not affect payments, nor will they affect TRICARE beneficiary's premium or benefits.
Other insurance companies may use similar methods, but each payer's program could yield different results since ratings are based on a unique set of claims data for a unique group of beneficiaries.
There are instances where a provider may not receive a rating and "Not enough information to measure" will appear in place of the rating symbols. There could be several reasons a provider does not receive a rating, such as: the specialty may not be among those evaluated, the provider's geographic location may not be in scope, the data may not be statistically credible or not enough data is available to complete a full evaluation.
Providers can access additional information by visiting Effectiveness and efficiency of care - program methodology.
Administrative claims including labs, pharmacy and medical.
Providers can submit detailed questions or feedback at any time by sending a secure message through provider self-service.
Yes, ratings are updated quarterly.
Humana Military is sharing information about your practice with its members and other providers. Provider ratings will help you and your TRICARE beneficiaries make better-informed healthcare decisions. If you would like to learn more about the program, please visit Effectiveness and efficiency of care - program methodology.
We ask that you review the reports for accuracy of information.
To access the reports, log in or register for provider self-service, then: