TRICARE provider tools

Provider education

Educating our providers on TRICARE policies and requirements is very important to us. That's why we make available our annual Provider Handbook to provide information on many TRICARE topics including: policy resources, healthy people 2020, HIPAA, signature on file requirements, provider types, provider certification and credentialing and much more.

Provider handbook

TRICARE East Region

The TRICARE East Region includes Alabama, Arkansas, Connecticut, Delaware, the District of Columbia, Florida, Georgia, Illinois, Indiana, Iowa (Rock Island Arsenal area only), Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Mississippi, Missouri (St. Louis area only), New Hampshire, New Jersey, New York, North Carolina, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas (excluding the El Paso area), Vermont, Virginia, West Virginia and Wisconsin.

CARE MANAGEMENT

Humana Military cares about the health of our TRICARE beneficiaries, and we offer several programs designed to help improve and sustain patients' health. These programs provide education and support, while encouraging members to adhere to their doctor's treatment plans. Learn more

Referrals & authorizations

If a necessary service is not available from the military hospitals and clinics or the patient’s Primary Care Manager (PCM), the PCM must request a referral from Humana Military. As the primary source of specialty care for TRICARE Prime beneficiaries, the military hospital or clinic has the Right of First Refusal (ROFR) to provide care for a TRICARE beneficiary. Learn more

TRICARE beneficiary eligibility

Providers must verify TRICARE eligibility for beneficiaries at the time of service. Providers should ensure the patient has a valid Common Access Card (CAC), uniformed services ID card or eligibility authorization letter. A CAC or ID card alone does not prove TRICARE eligibility. Learn more

PHARMACY & SPECIALTY PHARMACY

The TRICARE pharmacy program offers comprehensive prescription drug coverage for eligible TRICARE beneficiaries. It is administered by Express Scripts. In order for a beneficiary to fill a prescription, a written or electronic prescription order is necessary. All TRICARE beneficiaries with the exception of Active Duty Service Members, must obtain select brand name maintenance drugs through either their military pharmacy or through the TRICARE pharmacy home delivery program. Learn more