Tricare Provider Updates – 2018

January 18, 2018

Uncategorized

As the Managed Care Support Contractor for the TRICARE West Region effective Jan. 1, 2018, Health Net Federal Services, LLC (HNFS) is honored to begin serving beneficiaries in the TRICARE West Region. Your participation ensures active and retired military service members and their families will continue to have access to quality health care in the coming years.

Key things you need to know to prepare:

  1. Our complete West Region website – www.tricare-west.com – will be available Jan. 1, 2018.Tools launching that day include: check patient eligibility, submit claims, review referral and authorization requirements, submit requests for service (and check status), notify us of hospital admissions, update your demographics, sign up for electronic funds transfer (EFT) and electronic remittance advice (ERA), and more. Some tools require website registration, which is now available.
  2. HNFS will begin accepting referral and authorization requests, and claims, for 2018 dates of service on Jan. 1, 2018. We require network providers to use the HNFS online prior authorization and referral tools for all approval requests, and to submit claims electronically. Exception: Network providers in Alaska are not required to submit electronic claims.
  3. HNFS will honor referrals and authorizations issued by UnitedHealthcare Military & Veterans (UnitedHealthcare) through their expiration dates. Our online authorization status tool will include active referrals and authorizations issued by UnitedHealthcare that have an end date that extends beyond Jan. 1, 2018.
  4. If you haven’t done so, sign up for EFT and ERA. Save paper and get paid faster!
  5. Not sure who to contact or where to submit claims due to the West Region contractor transition? Use our printable Where to Submit Claims guide at www.tricare-west.com > Provider > Education/Quick Reference Charts as a resource. The TRICARE West Region electronic claims payer ID remains the same: 99726.
  6. The NDAA 2017 created significant changes to the TRICARE program, which go into effect Jan. 1, 2018. Key changes include:
  • TRICARE Select replaces TRICARE Standard and Extra. TRICARE Select is a self-managed, preferred provider network plan.
  • Beneficiary copayments and cost-shares are based on plan type and sponsor’s military status, and for some plans, the sponsor’s enlistment/appointment date. Beneficiaries are categorized as “Group A” and “Group B.” You‘ll notice these categories when reviewing costs at www.tricare-west.com.
  • Benefit enhancements, including the removal of referral requirements for TRICARE Prime beneficiaries seeking urgent care; expanded preventive services benefits for TRICARESelect beneficiaries who see network providers; and coverage of medically necessary foods and vitamins for those with metabolic disorders.

For more information, access our printable quick reference charts, webinar schedules, Benefits A–Z, FAQs, and the HNFS TRICARE West Region Provider Handbook at www.tricare-west.com.


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