Bene hero

2016

May 20

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.

Learn more

February 4

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.
  • Learn more

2015

December 15

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.

October 1

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

July 20

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

July 1

Breast pump and supply benefit information

TRICARE now covers breast pumps, breast pump supplies, and breastfeeding counseling as mandated by Section 706 of the Fiscal Year 2015 National Defense Authorization Act. The addition of this benefit is retroactive to December 19, 2014.

Going forward- Civilian Providers can request the equipment and supplies with a valid Certificate of Medical Necessity (CMN) or a physician order to the DME provider for qualifying TRICARE beneficiaries. Lactation counseling is covered as well, when available at facilities, clinics, or physician offices.

Shown below are a selection of National Network DME providers who specialize in breast pumps and supplies.

  • Aeroflow Healthcare 
    Phone: 844-867-9890
    Fax: 800-249-1513

  • Byram Healthcare
    Phone: 877-773-1972
    Fax: 800-521-6291

  • J & B Medical Supply
    Phone: 800-737-0045
    Fax: 800-737-0012

  • Pumping Essentials LLC     
    Phone: 866-688-4203
    Fax:888-506-2520
    Online:pumpingessentials.com

  • McKesson Patient Care Solutions
    Breast pump specialty line
    For breast pump orders
    Phone: 844-727-6667 (Providers)
    Phone: 855-406-PUMP (7867) (Beneficiaries)
    Fax: 855-716-2212

  • MEDELA INC
    Phone: 800-866-2825

  • Sunmed Medical Systems
    Fax Orders: 800-715-5422

  • Yummy Mummy
    Phone:  855-879-8669
    Fax: 855-291-5930
    Online:  www.yummymummystore.com

2014

December 23

Recent changes to the No Government Pay list for TRICARE

  • Urine drug screening codes listed below were added to the NGP list in October 2014: Codes 80100 and 80101 have been placed on the NGP list. Providers must utilize the Medicare drug screening codes G0431 and G0434 by encounter and no longer by drug class.  Screenings processed by Laboratories for TRICARE patients must now use the G codes.
  • The two flu vaccine codes listed below were on the NGP list and became covered preventive flu vaccines for TRICARE beneficiaries for 2014: Code 90687 for children 6-35 months of age and 90688 for individuals three years of age and older. Your PGBA claims processor for TRICARE will be reprocessing claims for the flu vaccine codes named ( where appropriate for the age of the beneficiary) early in 2015.

May 5

Pediatric PCM information - Same day wellnesss and sick visits
When a child presents for a sick visit and is due for a preventive visit, you may complete a well-child assessment, in addition to rendering for the presenting problem.

Mar 5

TRICARE demonstration project for approved Laboratory Developed Tests (LDTs)
Update on approved genetic testing under the Laboratory Developed Tests (LDT) Demonstration Project. Two new tests have been added to the LDT Demonstration project by TRICARE.

Feb 28

TRICARE service center walk-in service ending
As more people use convenient internet and phone options for their customer service needs, TRICARE is phasing out walk-in service at 189 TRICARE Service Centers (TSCs) across the 50 United States as of April 1, 2014. The majority of TSCs are located at military hospitals and clinics.

Overseas TRICARE Service Centers will not be affected due to the unique nature of the beneficiary audiences. Beneficiaries can get more information about these changes and sign up for TSC e-mail updates at tricare.mil/TSC .