It has been noted that a number of urgent care providers are collecting higher copays up front from Prime beneficiaries seeking urgent care.
Providers should only be charging the normal office visit copay of $12.00 for Prime beneficiaries seeking urgent care.
Beginning later in January, 2017, Prime beneficiaries for TRICARE may begin receiving letters from Quest Diagnostic Labs that include a colorectal screening kit with test instructions and return envelope. This preventive care initiative has been coordinated by Humana Military and Quest Labs in an effort to increase prevention screening options. Prime beneficiaries chosen for this outreach initiative are those assigned to civilian Primary Care Managers that are due or past due for colorectal screening or have no record of a timely screening colonoscopy. Humana Military wants to ensure that our valued Primary Care Managers are informed of this outreach effort to our Prime beneficiaries by providing this information.
Attached is a sample copy of the letter to the selected beneficiaries just in case your office is contacted by a beneficiary with questions.
Beneficiaries receiving the letter are directed to respond to Quest - by completing and mailing the test back to Quest timely. Where applicable, a copy of the results will be provided to the beneficiary from Quest labs regarding the colorectal screening test and share the results with their Primary Care Manager for follow up.
Medical Personnel who are part of the Uniformed Services-Active Duty, Reserve/Guard on Active Duty, Civil Service and government contracted employees cannot receive dual compensation for services provided to TRICARE beneficiaries.
Effective October 1, 2015, (DHA) Department of Health Affairs for the TRICARE program, added personal incontinence supplies as a covered item for qualified beneficiaries.
Per TRICARE Policy Manual: Chapter 9, section 13.1 - incontinence briefs are now covered for Active Duty Family Members enrolled in the ECHO program age 3 and older. Active Duty Family Members under the age of 3 and military retirees and family members are not included. The incontinence supply for the qualified beneficiary is paid out of the member’s annual ECHO program allowance.
HCPC codes covered in this benefit are:
*Certificate of medical necessity is not required for incontinence supplies ordered for the qualified ECHO beneficiary
**All services and supplies provided under the ECHO program require prior authorization
In accordance with the Centers for Disease Control and Prevention (CDC) guidelines, the FluMist vaccine is not covered for the 2016-2017 flu season. Due to questions surrounding the effectiveness of the nasal spray, the CDC's recommended vaccine for the prevention of the flu virus is the injectable or "intramuscular" flu shot.
CPT codes for FluMist (nasal spray) flu vaccine-90660 and 90672 are not payable in the claims processing system for TRICARE as of 10/16/16. For TRICARE beneficiaries seeking the flu vaccine, please ensure that only the intramuscular flu shot is given in order for the provider to be reimbursed.
TRICARE beneficiaries have the option to obtain the preventive flu vaccines from:
TRICARE beneficiaries have no out of pocket copay or costshare for preventive vaccines provided for by Network providers. For more information, please view the related health.mil article.
As a result of changes to the Mental Health and Substance Use Disorder benefit in section 1079 of the Code of Federal Regulations (CFR), TRICARE is changing a number of its mental health and substance use disorder (SUD) benefits. Many changes won’t go into effect until the spring of 2017; however, several major changes go into effect on Oct. 3, 2016.
Humana Military has added spinal fusion and related procedures to the prior authorization required list effective January 18th, 2016. The code look up feature provides direction to create a prior authorization request by procedure code to assist you in your submission.
The Humana Military team is committed to assisting both providers and beneficiaries after the recent incident in Chattanooga. We have collected resources on coping with tragedy and loss to assist in your crisis counseling. Please feel free to share with your TRICARE beneficiaries and the Chattanooga community as needed. We hope this information proves helpful in treating your patients.