Peer Review Organization (PRO) agreement

Humana Military has review authority over healthcare services provided in civilian facilities to Military Health System (MHS) beneficiaries in the TRICARE East Region.

To participate in the care of TRICARE beneficiaries, facilities must establish a Peer Review Organization (PRO) Agreement with Humana Military in accordance with (32 Code of Federal Regulations, (CFR) 199.2, 199.6, 199.15 [g] and TRICARE Operations Manual, Chapter 7, Section 1, 4.0).

The PRO agreement is separate from a network contract and network and non-network facilities are required to sign one. The agreement is a signed acknowledgement that Humana Military is the PRO for the TRICARE East Region.

If a corporation has multiple facilities, one signed agreement may cover all the facilities. Please attach a list that includes each facility and its respective tax ID and group NPI number.

The PRO agreement confirms that the facility will cooperate with Humana Military and its subcontractors by:

  • Providing copies of medical records
  • Providing accurate information on patients’ conditions
  • Informing patients of their rights and responsibilities
  • Providing other assistance that may be required for Humana Military to conduct comprehensive utilization and quality management programs for care of MHS beneficiaries who are patients of the facility

Download the agreement