TRICARE covers the non-surgical treatment of gender dysphoria when provided by a TRICARE-authorized provider...
The nasal spray, Spravato® (esketamine), is covered when deemed medically necessary to treat ..
To receive correct reimbursement, please ensure all required information is included, per TRICARE Policy Manual Chapter 4 Section 18.3...
Effective July 1, 2022, ground transportation from an airfield to an accepting medical facility is authorized and will be reimbursed at the Civilian Health and Medical...
Effective July 28, 2022, medical contraceptive consultations and services are considered integral parts of a well-woman exam....
When billing PHP services, revenue codes 0913 or 0912 should be filed with the correct Healthcare Common Procedure Coding....
Following the United States Supreme Court’s recent decision in Dobbs v. Jackson...
TRICARE updated its telemedicine Place of Service (POS) codes for dates of service on or after Jan 1, 2022, and included adding POS 10 to the telehealth codes.
Humana Military will accept the Notice of Admission (NOA) and Requests for Anticipated Payment (RAP), pending guidance from the Defense Health Agency (DHA).
Providers should be aware that we have updated claims information related to Certificates of Medical Necessity (CMN).
Exact Science has now joined the network and referrals are no longer required for dates of service on or after 6/1/22.
TRICARE’s new childbirth and breastfeeding support demonstration allows certified labor doulas, lactation...
Effective Oct. 28, 2019, TRICARE offers reimbursement for reasonable and necessary organ acquisition services and costs...
As part of TRICARE certification requirements, Applied Behavior Analysis (ABA) providers are expected to maintain...
Effective Feb 17, 2022, third-party billing agencies are no longer able to obtain basic claim status details from the call center and must use the express claims function ...
We are reminding providers that inquiries related to claims statuses are no longer being handled over the phone. Now, instead of contacting your TRICARE Community ...
Humana Military is awaiting the Defense Health Agency’s direction to adopt the Centers for Medicare and Medicaid Services (CMS) policy change for Calendar Year (CY)...
Providers should include the start and stop times on the individual claim lines when submitting claims, even when billing for multiple services rendered by the same...
TRICARE reimburses for Applied Behavior Analysis (ABA) services to eligible beneficiaries diagnosed with Autism Spectrum Disorder (ASD)...
To align with the Centers for Medicare and Medicaid Services (CMS), the Defense Health Agency (DHA) ended TRICARE’s HHVBP demonstration on...
TRICARE claims processor WPS is using Change Healthcare for EFT/ERA. Please direct all new enrollments and updates to Change...
Per TRICARE policy, concurrent billing is not permitted. Only one code should be billed when concurrent care services are performed. If both are...
Providers performing basic claim status inquiries must now use...
TRICARE will cover stool DNA testing (e.g. Cologuard™) once every three years starting at age 50 for those who have...
Effective September 13, 2021, TRICARE revised the clinical preventive services policy...
When billing for synchronous telemedicine/telehealth services, providers will use CPT...
A reminder about TRICARE’s annual, recurring claims transition process...
Humana Military is working diligently with the Defense Health Agency (DHA) to resolve the matter of the recoupments from freestanding...
Reimbursement for Durable Equipment (DE) and Durable Medical Equipment (DME), Prosthetics, Orthotics and Supplies (DMEPOS) is established by...
Due to a low response from Autism Corporate Service Providers (ACSP) in submitting a new participation agreement to remain TRICARE-authorized, the Defense Health Agency (DHA) has issued an extension through September 15...
Ablative Fractional Laser (AFL) treatment is approved under provisional coverage for emerging services and...
Medically necessary RPM services of physiologic parameter(s) including, but not limited to, weight, blood pressure...
WPS will begin processing HHA Request for Anticipated Payment (RAP) claims, bill type 322, with a work-around for the 2021 RAP NO-PAY processing guidelines...
Beneficiaries with current authorizations for CPT code 97156 (Patient/Caregiver Guidance) can no...
Due to a change in TRICARE ABA policy, all Autism Care Demonstration (ACD) Autism Corporate Service Providers (ACSP)...
The balance billing provisions for non-participating providers as outlined in...
Retroactive to January 1, 2021, TRICARE has implemented the following changes...
As a reminder, there is no limit to the number of days for TRICARE admissions to acute...
All Assistant Behavior Analysts and Behavior Technicians must submit their National Provider...
Effective Oct. 28, 2019, TRICARE offers reimbursement for reasonable and necessary organ acquisition services and...
TRICARE is adopting the Centers for Medicare and Medicaid Services (CMS) HVBP for hospitals, skilled nursing facilities and...
Effective January 1, 2020, TRICARE adopted the Centers for Medicare and Medicaid Services (CMS) New Technology Add-On Payments (NTAP) under...
We are aware that some users may experience performance issues with eligibility checks (270/271)....
Effective October 8, 2020, Home Health Agencies (HHA) in the following states will be required to adopt the Medicare HHVBP model...
Beginning January 1, 2021, the Defense Health Agency (DHA) has approved a demonstration to waive...
Effective October 30, 2020, clinical trials sponsored by or in collaboration with the National Institute of...
Effective September 30, 2020, TRICARE has expanded coverage for the use of investigational...
As a reminder, effective August 15, 2019, implantable Hypoglossal Nerve Stimulation (HGNS)...
Effective October 30, 2020, TRICARE no longer provides coverage for diagnostic imaging...
TRICARE recently revised the breast pump/breast pump supply benefit to include limits...
Due to a programming issue, we are experiencing delays in Primary Care Manager (PCM)...
COVID-19 serology/antibody testing is covered by TRICARE only when medically necessary and when...
The TRICARE Prescription Monitoring Program (PMP) is a quarterly review of beneficiaries receiving prescriptions for...
The Defense Health Agency (DHA) has issued new guidance on the use of telemedicine for TRICARE-covered...
If a beneficiary under your care requires fetal surgery, Humana Military has a dedicated phone...
TRICARE follows Medicare requirements for admission to a Skilled Nursing Facility (SNF). For admission to be...
On January 1, 2020, TRICARE revised its CGMS benefit to allow beneficiaries with uncontrolled diabetes to...
Under TRICARE’s Durable Medical Equipment (DME) benefit, beneficiaries who have been diagnosed with obstructive sleep apnea...
To improve virtual healthcare access during COVID-19, TRICARE has temporarily revised its telemedicine policy...
Retroactive to October 1, 2019, TRICARE has adopted the Medicare...
Effective April 16, 2020, TRICARE has approved Physical Therapy Assistants (PTA) and Occupational Therapy...
Retroactive to January 1, 2020, TRICARE manuals now include a Patient-Driven Groupings Model (PDGM) for Home Health Agency (HHA) reimbursement. Humana Military will release...
With provider offices across the country rescheduling patient appointments due to the COVID-19 outbreak...
Effective June 1, 2020, TENS unit as a standalone device, and the supplies to support the device, will no longer be covered...
TRICARE is announcing an exception to policy regarding the use of Telehealth (TH) capabilities for ABA services specifically during this COVID-19 pandemic...
The Department of Defense (DOD) is directing all military hospitals/clinics and DTFs to immediately postpone all elective surgeries...
Providers delivering telemedicine services during COVID-19...
Centers for Medicare and Medicaid Services (CMS) released a new Healthcare Common Procedure Coding System (HCPCS)...
In 2016, a new purchasing demonstration for Home Health Agencies (HHA) was introduced in five East Region states...
Learn more about and receive guidance on the emerging, rapidly evolving COVID-19 situation...
Effective January 1, 2020 TRICARE will cover Digital Breast Tomosynthesis (DBT), also known as...
Providers delivering telemedicine services must be licensed in the state(s) where the services...
In an effort to protect our user’s information and reduce the risk of the data being collected by inappropriate parties...
TRICARE now covers Banked Donor Milk (BDM) for infants with certain serious health conditions. Coverage applies...
We are aware of an issue with Durable Medical Equipment (DME) capped rental items being reimbursed incorrectly...
TRICARE recently revised the breast pump/breast pump supply benefit to include limits...
Sesame Workshop, in partnership with the DHA and TRICARE, is excited to announce a new multi-functional...
