As a reminder, gestational age must be over 20 weeks to qualify for the demonstration and this must be noted on the claim to ensure proper reimbursement/claims processing.
Provider requirements on the doula professional claim include:
TRICARE’s new childbirth and breastfeeding support demonstration allows Certified Labor Doulas (CLD), lactation consultants or lactation counselors to provide care to eligible beneficiaries. In the TRICARE East Region, the CBSD runs from January 1, 2022 to December 31, 2026 and eligible claims may be filed beginning April 2, 2022.
Beneficiaries enrolled in Uniformed Services Family Health Plan (USFHP), Continued Health Care Benefits Program (CHCBP), and those with TRICARE and Medicare coverage are not eligible for the CBSD.
While referrals are not required, Prime enrollees need a referral from their Primary Care Manager (PCM) or physician to see a non-network provider. Point-of-Service (POS) charges may apply without a referral.
Under the CBSD, eligible beneficiaries will receive breastfeeding counseling from an eligible lactation consultant or counselor as well as CLD services for beneficiaries with a gestational age over 20 weeks when under the care of a TRICARE-authorized provider. Lactation services are not covered until the beneficiary has a gestational age of 27 weeks.
Please note: Certified labor doula services for beneficiaries who give birth at a military hospital or clinic are excluded from the demonstration.
To become certified please complete an application here.
After TRICARE-authorized providers have completed the TRICARE certification process, they can choose to become a non-network participating provider, a non-network non-participating provider or a TRICARE network provider. All institutional providers must be participating providers. A TRICARE network provider has been certiﬁed for TRICARE and has a contract with Humana Military, following speciﬁc compliance rules deﬁned for network providers. Providers can request to join the network once they are certiﬁed.
A demonstration is a limited duration project that TRICARE uses to evaluate potential changes to the program. Although the services under the CBSD are covered for TRICARE beneficiaries as of Jan. 1, 2022, this is a new demonstration and establishing a provider network will take until April 2022*. If a TRICARE beneficiary wants to receive these services before the provider network is established, the beneficiary as well as their provider must meet the requirements of the demonstration. Otherwise, the beneficiary will be responsible for the full, out-of-pocket cost for the services.
*Please submit claims for services rendered on or after the implementation date of April 2, 2022.