News and updates


Avoid improper billing practices

September 1, 2023

Providers that make coding decisions that result in overbilling are committing fraud. Abuse can occur when a provider's billing practices, which may be direct or indirect, causes a financial loss even if there is not intent. One example of these practices that lead to overbilling is known as unbundling.


Unbundling occurs when multiple procedures/services are improperly billed separately, even though the group of services is covered by a single comprehensive code.  It can result in a higher reimbursement than the provider is entitled to receive.


Appending unwarranted modifiers to override the claims auditing software and allow additional payment for services that would normally be bundled is also considered fraudulent.


Unbundling fraud in the TRICARE program results in unlawful reimbursement at the taxpayer’s expense.  TRICARE providers are required to abide by all TRICARE program and Humana Military rules and guidelines for coding that are applicable when billing for services provided to beneficiaries. Manipulating CPT codes as a means of increasing reimbursement is considered improper billing practices and a misrepresentation of services billed.


Examples of fraud:       

  • Billing for costs of nonchargeable services, supplies or equipment disguised as covered items
  • Misrepresentations of description of services rendered

Submit your certification applications digitally

September 1, 2023

*Humana Military has moved all certification applications to a digital format, and starting October 1, 2023, will no longer accept paper or PDF applications. Providers who submit paper versions on or after October 1 will receive a letter back that they need to complete their application electronically, potentially delaying the certification process.


Please dispose of any paper applications or PDFs you have on hand, and instead access our most current, digital versions at


What are the benefits of digital certification applications?

  • Faster processing time
  • Instant electronic confirmation of receipt
  • Check applicaiton status online
  • Improved submission accuracy
  • Real-time feedback
  • Captures all necessary attachments
  • Prevents submission of incomplete applications
  • Less touchpoints—no need to call or email to confirm receipt or follow-up


Thank you for your cooperation as continue to work to enhance the certification application process.


*After October 1, the only remaining print certification applications will be Telehealth Only applications.  

Update to TRICARE's Childbirth and Breastfeeding Support Demonstration (CBSD)

August 24, 2023

TRICARE’s Childbirth and Breastfeeding Support Demonstration allows Certified Labor Doulas (CLD), lactation consultants or lactation counselors to provide care to eligible beneficiaries.


Effective July 25, the following telemedicine services for the CBSD are no longer included:

  • Audio-only breastfeeding counseling
  • Antepartum and postpartum care visits


Please note: All childbirth support services provided by a Certified Labor Doula (CLD) must be in-person.


As a reminder, providers must use a two-way visual component to provide breastfeeding support services via telemedicine.


To verify you are able to continue to provide these services, please review Telemedicine for providers.


For more information on the CBSD, visit TRICARE Operations Manual and CBSD provider resources.

Referrals and authorizations are going digital!

August 22, 2023

Humana Military is preparing to move all referrals and authorizations to electronic submissions by the end of 2023 and will no longer accept hard copy faxes. Through provider self-service, you can submit multiple documents for new and existing referrals and authorizations.  


If you are not currently using electronic submissions, are unable to access provider self-service or have barriers when attempting to use electronic submissions for your referrals or authorizations, please fill out this survey to let us know how we can help you.


If you need a self-service account to begin submitting online you can create one today! For those providers who are already submitting referrals and authorizations through provider self-service- thank you!


See referrals and authorizations or referral/authorization demonstration or FAQs

Update to Laboratory Developed Test (LDT) demonstration

August 18, 2023

The Laboratory Developed Test (LDT) demonstration has been extended through July 18, 2028, and the following LDTs have been added: 

  • Biotheranostics Breast Cancer Index
  • DermTech Pigmented Lesion Assay (PLSA)
  • FoundationOne Heme
  • MDxHealth Confirm MDx 
  • MDxHealth Select MDx

Cystic Fibrosis (CF) carrier screening is now covered under the TRICARE basic benefit as a preconception and prenatal carrier screening test, as well as under the LDT demonstration for the following indications:

  • confirmation of diagnosis in individuals showing clinical symptoms of CF or having a high sweat chloride level.
  • identification of newborns who are affected with CF.
  • identification of individuals with the p.Gly551Asp variant who will respond to treatment with ivacaftor.
  • male infertility testing and treatment.


Learn more about LDTs


TRICARE Manuals - Chap 18 Sect 3 (Change 125, Jul 28, 2023) (  

Silicon Valley Bank (SVB)/ Signature Bank closures

March 17, 2023

The Federal Deposit Insurance Corporation (FDIC) announced that it has assumed control of Silicon Valley Bank (3/10/23) and Signature Bank (3/12/23) to meet the needs of its depositors and ensure there are no risks to the account holders. As such, the FDIC has established bridge banks and moved all deposits to these respective banks to ensure access by the account owners with little interruption of services. This process should be seamless to the account holders; more information is available on the FDIC website.

Earlier this week, claims payments were suspended for providers with these banking arrangements until the initial assessment of this issue was compete. The assessment is now complete and at this point, we do not see an inherent issue with provider payments based on the information available from the FDIC. As such, payments currently held will be released and issued in the normal time frames.

If providers wish to change their current payment arrangements to a different bank or select paper checks, they can visit the WPS/Change Healthcare portal for Electronic Funds Transfer (EFT)/ Electronic Remittance Advice (ERA) or learn more by viewing these FAQs on how to change a healthcare payer’s enrollment services.

We apologize for any inconvenience this may cause, but we wanted to ensure receipt of payments in a secure manner for the services provided. Please reach out to your local TRICARE Community Liaison (TCL) should you need further assistance.

Access to Spravato®

March 16, 2023

The nasal spray, Spravato® (esketamine), is covered when deemed medically necessary to treat beneficiaries with treatment-resistant depression and other US Food and Drug Administration (FDA)-approved indications, which are available in the FDA’s Risk Evaluation and Mitigation Strategy (REMS) program. This benefit is covered under the medical benefit, not pharmacy, and prior authorization is required.

While Walgreens is not a network provider at this time, prescriptions for Spravato (esketamine) can be filled through Walgreens Specialty Pharmacy.

Update on New Technology Add-On Payments (NTAP)

March 7, 2023

To align with the Calendar Year (CY), if the Centers for Medicare and Medicaid Services (CMS) creates a new Medicare Severity (MS)-TRICARE Diagnosis Related Group (DRG) payment, TRICARE provides a three-month grace period (October 1 through December 31) for expired New Technology Add-On Payments (NTAP).

If a new MS-DRG is not established for an NTAP, the grace period does not apply.

Reimbursement changes for Home Health Agencies (HHA)

February 6, 2023 update

To align with the Medicare Claims Processing Manual (CPM), Home Health Agencies (HHA) must submit a Notice of Admission (NOA) for periods of care with dates of service on or after January 1, 2022.

Effective February 6, 2023, Humana Military will no longer accept Requests for Anticipated Payment (RAP). Providers who previously submitted RAPs and received reimbursement are not required to take further action.

TRICARE Reimbursement Manual (TRM) Ch 12, Sec 9

Home Health Agency (HHA) reimbursement FAQs

June 15, 2022

Update Humana Military will accept the Notice of Admission (NOA) and Requests for Anticipated Payment (RAP), pending guidance from the Defense Health Agency (DHA). Until then, you will see Requests for Anticipated Payment (RAP) information on the Explanation of Benefits (EOB).

March 4, 2022 - Update

Humana Military is awaiting the Defense Health Agency’s direction to adopt the Centers for Medicare and Medicaid Services (CMS) policy change for Calendar Year (CY) 2022. Until it has been received, we will continue to follow current guidance as written in the TRICARE Reimbursement Manual Chapter 12, Section 9

Requests for Anticipated Payment (RAP) for CY 2021 and the implementation of a new one-time Notice of Admission (NOA) process start in CY 2022.

Retroactive to January 1, 2021, TRICARE has implemented the following changes.

National Operating Standard Cost as a Share of Total Costs (NOSCASTC)

The NOSCASTC for calculating the cost-outlier threshold for Calendar Year (CY) 2021 is .926. The cost-outlier uses a cost-per-unit rather than cost-per-visit approach with a limit of 32 units or eight hours per day.

Split percentage payments and Requests for Anticipated Payment (RAP)

HHAs certified for participation in Medicare on or after January 1, 2019, will no longer submit split-percentage or RAP payments. HHAs that are certified for participation in Medicare effective on or after January 1, 2019, will still be required to submit a “no pay” RAP at the beginning of care to establish the home health period of care, as well as every 30 days thereafter upon implementation of the Patient Driven Groupings Model (PDGM). Because the level of care can change during the 30-day period of care, the Health Insurance Prospective Payment System (HIPPS) codes will determine the final payment amount.

Low Utilization Payment Adjustment (LUPA)

For periods of care beginning on or after January 1, 2020, if an HHA provides fewer than the threshold of visits specified for the period’s Home Health Resource Group (HHRG), they will be paid a per-visit payment instead of a payment for a 30-day period of care. This payment adjustment is called a LUPA. Under PDGM each of the 432 case-mix groups has a visit threshold ranging from two to six visits to determine whether the period of care meets the LUPA threshold.

Under PDGM, if the LUPA threshold is met, the 30-day period of care is reimbursed at the full 30-day national, standardized payment amount. For periods of care that do not meet the LUPA threshold, reimbursement shall be at the appropriate CY per-visit payment amount.

Abortion billing tips

November 30, 2022

To receive correct reimbursement, please ensure all required information is included, per TRICARE Policy Manual (TPM) Chapter 4 Section 18.3.

Claims must be submitted with the following:

G7 modifier, which is defined as the pregnancy resulted from rape or incest, or pregnancy certified by physician as life threatening

One of the condition codes listed below: 

AA - Abortion performed due to rape;

AB - Abortion performed due to incest;

AD - Abortion performed due to life endangering physical condition

For more information, visit

Update on non-surgical treatment of gender dysphoria

February 3, 2023

TRICARE covers the non-surgical treatment of gender dysphoria when provided by a TRICARE-authorized provider. Non-active duty beneficiaries do not need a referral or preauthorization for outpatient, office-based, mental/behavioral health visits.

Effective July 1, 2022, treatment team conferences (CPT 99366, 99367, 99368) are also reimbursable under the TRICARE benefit.

Gender affirming hormone therapy for adults or adolescent beneficiaries is covered when criteria outlined in the most current version of the Endocrine Society Clinical Practice Guidelines for Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons are met and there are no contraindications to gender-affirming hormone therapy to receive endocrine therapy.

All services and supplies related to surgical treatment for gender dysphoria, including but not limited to, mastectomy, oophorectomy, and orchiectomy, are excluded.

See TRICARE Policy Manual (TPM) Chapter 7, Sections 1.3 and 3.8 for more information.