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August 2018

View remittances in a few simple steps at HumanaMilitary.com!

  • Simply log in to provider self-service and go to "Provider Access Claims Center" under the "Claims" section
  • Select the "Remittance" tab to enter the "Check Number","Begin date" or "End date"
  • Click "Search" to populate the results using the dates entered

In the next provider bulletin

We will explore information around Other Health Insurance (OHI).

July 2018

Submit claims easily and conveniently!

Processing and submitting claims electronically is easy with self-service

After selecting the patient from the drop down menu, simply enter the claim data (including any supporting documents), review the details entered and submit the claim. Once the submission is complete, providers will receive acknowledgement the claim was successfully submitted and the claim number is provided.

Providers may also submit claims using their Practice Management System or clearinghouse software to submit directly to WPS. Please make sure you have updated and are using the NEW TREST payer ID. As a reminder, TRICARE requires providers to file claims electronically with the appropriate HIPAA-compliant standard electronic claims format.

June 2018

Simplify EDI and go paperless

Electronic Data Interchange (EDI) is a paper-free way for you to file and manage multiple aspects of your claims. TRICARE East Region providers can simplify claims submission, view remittances, receive claims payment and more.

Once set-up is complete, EDI processes can be done either through your current clearinghouse or practice management system, or by accessing your self-service account

If you haven't yet signed up for EDI through our claims processor, Wisconsin Physicians Service (WPS), do it today! Complete the online self-registration process through the WPS EDI enrollment system

EDI help desk: (800) 782-2680 (option 1)

Email: edi@wpsic.com

Learn more

May 2018

TRICARE's vision benefit coverage updates

TRICARE's vision benefit coverage of eye exams, glasses and contacts, depends on the beneficiary, his or her age and which TRICARE plan he or she is enrolled in.

Eye exams are covered under TRICARE. Clinical preventive eye exams include a comprehensive screening for determination of vision on visual acuity, ocular alignment and red reflux, along with external examination for ocular abnormalities. Routine eye examinations include an evaluation of the eyes not related to medical or surgical condition; including but not limited to refractive services. Routine eye examinations are meant to be more than the standard visual acuity screening test conducted by the member's primary care physician. Self-referral to a network provider will be allowed for these routine eye examinations.

In general, TRICARE covers routine eye exams:

  • As needed for Active Duty Service Members (ADSMs) to maintain fitness for duty
  • Once a year for Active Duty Family Members (ADFMs)
  • Every two years for all other TRICARE Prime beneficiaries (e.g. retired service members, their families, etc.)
  • As medically necessary for TRICARE diabetic beneficiaries

ADSMs and activated guard/reserve members can get glasses from the optometry clinic at their military hospital or clinic. Except for ADSMs, contact lenses or eyeglasses are only covered for treatment of conditions such as:

  • As needed for ADSMs to maintain fitness for duty
  • Once a year for ADFMs
  • Every two years for all other TRICARE Prime beneficiaries (e.g. retired service members, their families, etc.)
  • As medically necessary for TRICARE diabetic beneficiaries

May 2018

Have you updated your claims contact information?

Effective 5/1/2018, PGBA will no longer process claims or accept claims calls, regardless of the claim’s date of service. All new claims and claims adjustments are handled by WPS. Claims information can be found using provider self-service tools on HumanaMilitary.com, or by contacting a representative using chat, secure messaging, or calling (800) 444-5445.

As a reminder, please be sure to update any stored or archived address, phone, or fax information with the current contact information to prevent a delay in future claims payment. If submitting a claim by mail, please send to the following address:

TRICARE East Region
Wisconsin Physicians Service
Attention: Claims
PO Box 7981 Madison, WI 53707

For additional contact information

May 2018

Cold therapy devices are not covered

This clarification is to alert East Region providers who may not be familiar with this coverage exemption.

Orthopedic cold therapy devices are not covered under TRICARE policy. Per TRICARE Policy Manual Chapter 8, cold therapy devices fall under the designation of Durable Medical Equipment (DME) with deluxe, luxury or immaterial features and are excluded from coverage.

Learn more

March 2018

Provider seminars

Our provider seminars offer information and news on many topics including TRICARE education, provider self-service and many other helpful tips. Network providers can register now for upcoming sessions by entering their nine-digit provider ID (nine-digit tax ID). A link to the seminar will be emailed out the day before each session to registered users. Open dates and sessions are available now for upcoming seminars.

Topics include:

Provider orientation

As an introduction to TRICARE, this seminar will cover basic education including TRICARE details, plan descriptions and information. Topics include program options depending on status and location, coverage options, specialty and emergency services, ID card processing, reports and policies and pharmacy and dental options.

TRICARE ABA

Network providers can attend this session which will cover autism care demonstration, TRICARE certification requirements, Humana Military credentialing requirements, referrals and authorizations, claims requirements, forms and key provider resources.

Humana Military provider self-service

Have you signed up for provider self-service? This demonstration includes guidance in using provider self-service on HumanaMilitary.com. Instructions for using the portal include registration, site administrators, claims information and self-service features such as referrals, code look up, provider information and patient eligibility.

Humana Military provider self-service referrals and authorizations

This seminar will guide users through training on how to view, submit and update referral or authorization requests through provider self-service. Time will be permitted for any questions providers may have about this training or other features on provider self-service.

Update your provider directory information today!

It is important to ensure Humana Military has the correct information on file regarding your practice. This includes the following information:

  • Practice name
  • Office locations
  • Billing addresses
  • Email address
  • Business phone
  • Business fax

Please use provider self-service to verify or update any contact, location or communication information. Provider self-service offers a number of tools and resources for including:

  • Submit claims
  • Claims status
  • View and submit changes to provider demographic information
  • Communication preferences
  • Remittance advice
  • And much more!

After you register, your account will be activated within two to three business days.

Register for self service now