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: