Humana Military Provider

News and updates for providers

January 25, 2017

Urgent Care Pilot Program- Reminder to providers

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.

January 11, 2017

Attention TRICARE Primary Care Managers,

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.

October 21, 2016

ALERT to TRICARE network on “moonlighting” by Active Duty/Government employed providers

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.

September 2016

Current information on zika virus

TRICARE is following the CDC website for guidance on testing and reporting Zika virus. Please utilize the web links provided for up to date information and guidance on testing and reporting suspected Zika virus with your patients.

Helpful resources

    February 4, 2016

    Zika virus disease in the United States, 2015–2016 (as of February 3, 2016)

    • Zika virus disease is a nationally notifiable condition. Cases are reported to CDC by state and local health departments.
    • This update from the CDC Arboviral Disease Branch includes provisional data reported to ArboNET for January 1, 2015 – February 3, 2016.
    • As of February 3, a total of 35 Zika virus disease cases have been reported to ArboNET from U.S. states. No locally acquired cases have been reported from the continental United States
    • To date, 9 locally acquired cases and 1 travel-associated case have been reported from U.S. territories, including Puerto Rico and the U.S. Virgin Islands.

    October 1, 2015

    ECHO program enhancement

    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:

    • A4520 incontinence garment, any type
    • T4521 – T4536, T4539, and T4543-T4544 DME incontinent products

    *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

      November 7, 2016

      Alert to providers on the FLU vaccine for 2016-2017

      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:

      • Military hospitals/clinics where immunizations are available
      • Network pharmacies
      • Network providers, including convenience care clinics

      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 article.

      October 3, 2016

      TRICARE mental health benefit and cost changes

      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.

      May 20, 2016

      Urgent care pilot program

      The National Defense Authorization Act (NDAA) 2016, Section 725, has activated this pilot to determine the possible elimination of referrals for urgent care visits and improve access to immediate care from an Urgent Treatment Center rather than an Emergency Room. The urgent care visit can also be provided by a network physician’s office. This pilot program goes into effect May 23, 2016 and will continue until May 23, 2019.

      December 15, 2015

      Spinal fusion and related procedures now require prior authorization

      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.

      July 20, 2015

      Recent incident in Chattanooga

      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. 

      Helpful resources


        View past notifications and changes within the TRICARE program and provider processes that impact our provider community.