december 9, 2011 - bcbsks eseminar is for autism providers who will learn about the autism benefit,...
TRANSCRIPT
DECEMBER 9, 2011
TODAY’S PRESENTERS AND
CONTACT INFORMATION Connie Winkley, Education Coordinator,
Institutional Provider Relations, Blue Cross and Blue Shield of Kansas [email protected], 785-291-7236
Cindy Garrison, CPC
Provider Consultant, Institutional Provider Relations, Blue Cross and Blue Shield of KS Hospitals in Northern Kansas [email protected], 785-291-8862
Denny Cassel Hartman, CPC Provider Consultant, Institutional Provider Relations, Blue Cross and Blue Shield of KS Hospitals in Southern Kansas [email protected], 316-269-1602
Marie Burdiek, EDI Account Representative, EDI Operations, Blue Cross and Blue Shield of Kansas [email protected], 785-291-4130
BCBSKS AGENDA Blue Cross and Blue Shield of Kansas
• Availity • ICD-10
CPT Code Changes for 2012 EDI - Electronic Data Interchange
• HIPAA 5010
TRICARE/TriWest
AVAILITY: BCBSKS Future Secure Web site Access for Member’s Eligibility and Claim Status effective in 2012 What is Availity?
Availity offers a multi-payer portal at www.availity.com that gives physicians, hospitals and other health care providers secure access to multiple payers’ information through a single sign-on. Availity offers a variety of business and clinical solutions to help providers reduce administrative costs by eliminating paperwork and phone calls. Availity is one of the nation’s largest electronic health information networks, processing more than a billion transactions each year. Why is Blue Cross Blue Shield of Kansas teaming with Availity?
Our relationship with Availity will help remove costs from the system by streamlining transactions and processes. This will help reduce the amount of paperwork for medical practices, allowing physicians to spend more time with patients. What are the advantages of using Availity? • No Charge – Health plan transactions are available at no charge to providers.
• Accessibility – Availity functions are available 24 hours a day from any computer with Internet access.
• Standard responses – Availity returns responses from multiple payers in the same format and screen layout, providing users with a consistent look and feel.
• Commercial and Government Payers – Access to data from BCBSKS, Medicare, Medicaid and other commercial insurers. A full list of participating payers for each state by participation type is available at www.availity.com > Info for Providers > View Availity Health Plan Partners. The link to ‘View Availity Health Plan Partners’ can be found on the right hand side of the ‘Info for Providers’ page.
• Compliance – Availity is compliant with the Health Insurance Portability and Accountability Act (HIPAA) regulations. Availity’s statement of compliance is available at www.availity.com. Select Info for Providers and then Regulatory Compliance. The link to Regulatory Compliance can be found on the right hand side of the Info for Providers page.
• Training – Availity offers free live and pre-recorded Web-based training seminars (webinars). Providers simply log into the Availity portal and register to attend the webinars of their choice. Demonstrations, frequently asked questions and comprehensive help topics are available online as well.
What services are available through Availity?
Providers can use the portal for the following BCBSKS member transactions: • Eligibility and Benefits • Claim Status
Additional services and functions may be available from other payers. Who should providers call if they have questions about Availity?
Contact Availity Client Services toll free at 800-Availity (800-282-4548) or e-mail questions to [email protected]. Availity Client Services is available Monday through Friday 8 a.m. to 7 p.m. ET (excludes holidays). For other assistance: • Availity Help
In Availity, click Help at the top of the page. Browse the books and topics as necessary
• Show Me Demos –
For a demonstration of many tasks available on Availity, go to www.availity.com, on the Home page under Availity Training and Resources, click Show Me Demos. Click any of the categories to expand them. Click a blue triangle to launch a demo.
• Live and Pre-recorded Webinar Training
Availity offers live training conducted by phone and teleconferencing tools. To see the schedule and enroll: In Availity, click Free Training on any page. Click Live Webinar Schedule. To enroll, click a webinar title and follow the instructions on the page that displays.
If I already have access to BCBSKS’s web site, will I need to register to use the Availity® Health Information Network?
Yes. The Availity Health Information Network requires that you register and obtain a user ID and password. Once logged in to Availity’s network, you have the ability to transact with multiple health plans, eliminating the need to visit multiple sites and remember multiple passwords. What are the technical requirements? All a provider needs to access Availity.com is: • A computer with internet access. High speed is recommended for best
results • Microsoft Internet Explorer 6.0 or greater, which supports 128-bit
encryption. • A 1024 x 768 or greater pixel display for best results.
ICD-10 Mapping - General Equivalence Mapping (GEM) Look-up Tool
Log into BlueAccess and click on ICD-10 Mapping
1. Single Diagnosis Code Retrieval
WELCOME INSTITUTIONAL PROVIDER
2. Diagnosis Code Range Retrieval (Choose by code and page number to retrieve GEM)
3. Description Look-Up
(Choose by code and page number to retrieve GEM)
4. Single ICD-10 Diagnosis Code
5. Single ICD-10 Procedure Code
TriWest Provider Services
“TRICARE” is a registered trademark of the TRICARE Management Activity. All rights reserved.
TriWest Healthcare Alliance provides access to quality health
care for 2.9 million members of America's military family in the 21-
state TRICARE West Region.
HO1182011-9/30/2011
Webinars, eSeminars Available TriWest Healthcare Alliance (TriWest) has developed various webinars and eSeminars to help you learn
about TRICARE and TriWest.
Webinars are training sessions from your own computer with a live instructor in which you can ask
questions and also hear questions asked by other providers attending the training. eSeminars allow
you to learn about TRICARE and TriWest in the comfort of your own office, home or any location with
Internet access.
Here is a list of webinars that are currently available on the following topics:
Title Description
Behavioral Health TRICARE 101 This webinar is for behavioral health professionals and facilities
and gives a comprehensive review of TRICARE programs,
TRICARE/TriWest administrative requirements, and provider
resources.
TRICARE 101 This webinar is for medical/surgical professionals, facility, and
ancillary providers and gives a comprehensive review of
TRICARE programs, TRICARE/TriWest administrative
requirements, and provider resources.
Ambulatory Surgery This webinar is for outpatient surgery providers subject to ASC
grouper reimbursement. Information about authorizations,
claims submission and reimbursement, and provider resources
relevant to outpatient surgery providers is provided.
Autism This webinar is for autism providers who will learn about the
Autism benefit, the two options for providing Autism services to
TRICARE beneficiaries, authorization requirements, submitting
claims, and reimbursement for Autism services.
Electronic Data Interchange (EDI) This webinar discusses the benefits, advantages and the
workflow for your online claims process. You will learn about
the following topics: EDI transmission options, guidelines for
other health insurance and secondary claims, electronic
remittance advices, electronic funds transfer, and how to
access and use the claims status report. You will also learn
about 5010 and ICD-10 and provider resources.
PT/OT/ST This informative Physical Therapy/Speech Therapy/
Occupational Therapy webinar covers TRICARE’s physical
therapy, speech therapy, and occupational therapy benefits
in an outpatient setting, authorization requirements, and
claims submission.
Secure Website-Claims Want to save time with your claims submission and Accounts
Receivable? The Secure Website-Claims webinar will show you
how to streamline your work relating to online claims
submission for your TRICARE West Region patients and other
time saving tools, including claims status and online claims
correspondence/webmail.
TriWest Provider Services
“TRICARE” is a registered trademark of the TRICARE Management Activity. All rights reserved.
TriWest Healthcare Alliance provides access to quality health
care for 2.9 million members of America's military family in the 21-
state TRICARE West Region.
HO1182011-9/30/2011
Title Description
Secure Website-Referrals and
Authorizations
Want to save time submitting your referral and authorization
requests and get an almost immediate response in most
cases? The Secure Website-Referrals
and Authorizations webinar will show you how to streamline
your work relating to referrals and authorizations for your
TRICARE West Region patients.
TriWest Online Care Behavioral Health
Webinar
This webinar is designed for providers interested in
participating in Tele-Behavioral Health Care as originating sites
or distant providers.
Vision Coverage The vision coverage webinar was developed for vision
providers and gives a comprehensive review of the TRICARE
vision coverage.
Here is a list of eSeminars that are currently available on the following topics:
Title Description
Behavioral Health TRICARE 101 This eSeminar is for behavioral health professionals and
facilities and gives a comprehensive review of TRICARE
programs, TRICARE/TriWest administrative requirements, and
provider resources.
TRICARE 101 This eSeminar is for medical/surgical professionals, facility, and
ancillary providers and gives a comprehensive review of
TRICARE programs, TRICARE/TriWest administrative
requirements, and provider resources.
Ambulatory Surgery This eSeminar is for outpatient surgery providers subject to ASC
grouper reimbursement. Information about authorizations,
claims submission and reimbursement, and provider resources
relevant to outpatient surgery providers is provided.
Autism This eSeminar is for autism providers who will learn about the
Autism benefit, the two options for providing Autism services to
TRICARE beneficiaries, authorization requirements, submitting
claims, and reimbursement for Autism services.
Electronic Data Interchange (EDI) This Electronic Data Interchange (EDI) eSeminar discusses the
benefits, advantages and the workflow for your online claims
process. You will learn about the following topics: EDI
transmission options, guidelines for other health insurance and
secondary claims, electronic remittance advices, electronic
funds transfer, and how to access and use the claims status
report. You will also learn about HIPAA 5010, and ICD-10 and
provider resources.
Extended Health Care Option (ECHO) This eSeminar is for Extended Care Health Option (ECHO)
providers. ECHO supplements the basic TRICARE benefit for
active duty family members with special needs. This eSeminar
provides important information to understand the ECHO
benefit and provider responsibilities and administrative
requirements.
Home Health Agency Prospective
Payment System
This eSeminar is for home health providers and gives an
overview of the home health benefit and related
administrative requirements.
TriWest Provider Services
“TRICARE” is a registered trademark of the TRICARE Management Activity. All rights reserved.
TriWest Healthcare Alliance provides access to quality health
care for 2.9 million members of America's military family in the 21-
state TRICARE West Region.
HO1182011-9/30/2011
Title Description
Outpatient Prospective Payment
System (OPPS)
This eSeminar is for hospitals and other facilities subject to
OPPS reimbursement and provides an overview of the
reimbursement methodology.
TRICARE’s Hospice Benefit This eSeminar is for hospice providers and gives an overview of
the hospice benefit and related administrative requirements.
TriWest Online Care Program This eSeminar provides information for Originating Site and
Distant Site Providers participating in the TriWest Online Care
program (tele-behavioral health).
Vision Coverage The vision coverage eSeminar was developed for vision
providers and gives a comprehensive review of the TRICARE
vision coverage.
Additional webinars and eSeminars will be added for your convenience, as needed.
TriWest Provider Services
“TRICARE” is a registered trademark of the TRICARE Management Activity. All rights reserved.
TriWest Healthcare Alliance provides access to quality
health care for 2.9 million members of America's military
family in the 21-state TRICARE West Region.
HO1172011-9/30/2011
Website Demonstrations To view website demonstrations, go to TriWest.com/provider, then click the blue button “Website
Demonstrations.”
Links to Topics Descriptions
Account Administration Learn how to manage your online account
Eligibility Learn how to check eligibility online
West Region Benefit Lookup Tool
Learn to research covered benefits and check
referral/authorization and medical review
requirements for specific codes
Online Referral/Authorization Submission
Choose from three website demonstrations on
online referral/authorization submission:
Medical/Surgical, Inpatient Notification, and
Behavioral Health.
Practice It! Take the online referral/authorization submission
demonstration and then spend some time
“interactively” practicing with the application.
Online Referral/Authorization Status
Learn how to check the status of a referral or
authorization online
Online Claims Submission
Choose from two website demonstrations on
submitting claims online: UB-04 and CMS-1500, or
access a tip sheet on submitting corrected,
replacement, and void/cancelled claims
Online Claims Status Learn how to check the status of your claims online
Online Claims Correspondence/Webmail
Learn how to correspond with TriWest online regarding
claims issues/inquiries and your secure account at
TriWest.com/Provider
TriWest is continually improving the functionality on our secure website to better serve
providers. The secure website applications described in these demonstrations may
change before these demonstrations are updated.
Cut the Cord and Go Online! TriWest Healthcare Alliance’s self-service tools for providers and their office staff can make daily office
work more convenient, immediate, faster and easier.
Convenient
Using the tools offered on TriWest’s secure provider website allows you to conveniently check your
patients’ eligibility, submit and check status of referrals and authorizations, as well as submit and check
status of claims, and much more!
Immediate
Did you know that most referrals and authorizations properly submitted through TriWest’s secure provider
website are processed automatically within minutes? Now, your patients can get the care they need
faster and you can move on to the next task at hand.
Faster
No one likes to wait to get paid and with electronic claims submissions, you won’t wait long! On average,
90% of “clean” claims submitted online are processed in less than five days—more than 10 days faster
than submitting paper claims.
Easier
Stay up-to-date with TRICARE®! After registering online, you will automatically receive exclusive access to
the West Region Benefit Lookup Tool at TriWest.com/Provider>Eligibility—an easier way to check benefits
and eligibility.
Plus, you’ll receive TRICARE eNews with resources and TRICARE updates, including billing, reimbursement,
and benefit changes and more—all direct to your email account!
Not registered? Register today by clicking the orange “Register Now” button in the top right-hand corner
of TriWest/com/Provider. To make the registration process as easy as possible, make sure you have the
following information available before you register:
Your Tax ID number
License number, Medicare number or NPI (National Provider Identifier)
One of the following:
o Two claim numbers (from TRICARE West-Region Claim remittance advices)
o Two authorization reference numbers
o One claim number and one reference number
In addition, you will need the date of birth of the beneficiary or beneficiaries from the internal control
number (ICN) or reference number.
Need help registering? If you don’t have the information needed to register for the secure website, you
can click on the Contact Us link at the bottom of TriWest.com or call WPS EDI at (800) 782-2680 for
assistance.
Already registered? Start taking advantage of the convenient online tools available now at
TriWest.com/Provider.
“TRICARE” is a registered trademark of the TRICARE Management Activity. All rights reserved.
TriWest Provider Services
“TRICARE” is a registered trademark of the TRICARE Management Activity. All rights reserved.
TriWest Healthcare Alliance provides access to quality
health care for 2.9 million members of America's military
family in the 21-state TRICARE West Region.
HO2922011-9/28/2011
Don’t Wait – Update! Check Your Information Today
Have you moved into a new office recently? Changed your telephone number? Have more
missed appointments or patients arriving late for appointments?
If you answered yes to any of these questions, you need to take a minute to check your
information on the TriWest Provider Directory to update your contact information. To verify your
information, go to TriWest.com and click on Find a Provider at the top of the page.
If a change is necessary, go to TriWest.com/UpdateNow to find your Local TRICARE
Representative. It is important to provide your Local TRICARE Representative with demographic
updates like changes in physical location, tax identification number, telephone number, claims
payment address, email addresses for staff working with TRICARE, etc.
We thank you for taking the time to verify your information and for the service you provide to
TRICARE beneficiaries.
TriWest Provider Services
“TRICARE” is a registered trademark of the TRICARE Management Activity. All rights reserved.
TriWest Healthcare Alliance provides access to quality health care for 2.9
million members of America's military family in the 21-state TRICARE West
Region.
FL-49-2009-8/3/2011
Why Share Your Email Address With TriWest?
Our Goals
Communicate the right information to the right person at the right time
o Inform you about TRICARE program changes and TriWest processes to ensure that you have
the information you need to receive reimbursement quickly and efficiently
o Provide resources to help you care for TRICARE beneficiaries, including those active duty
service members in your community who may have recent combat experience
o Notify you of educational opportunities or events in your community, including live continuing
education conferences, live provider education seminars, and open houses hosted by Military
Treatment Facilities
o Quick alerts, which when you opt-in, will notify you when your online transactions have been
completed or for important updates regarding the secure website
Our Method
Targeted, timely email communications based on your:
o Geography
o Provider specialty or facility type
Our Commitment to You
We will not sell or distribute your email address to other companies, with the exception of your local
TRICARE representative.
We will not send spam emails; all communications will be for TRICARE/TriWest-related information only.
We will not overload your email account; we generally send an eNewsletter every 2-3 weeks.
Our Next Steps
Continue to gather provider email addresses and the information needed to get the right message to the
right person
Your Next Steps
Share your email address in one of the following ways:
Register for secure website access at TriWest.com/provider
Sign up for the TRICARE eNews at TriWest.com/provider
Give your email address to your local TRICARE representative
When you receive an online request to complete your “profile” for purposes of email
communications, please respond.
Make sure you add [email protected] to your safe sender list to ensure our eNewsletters reach
you.
TriWest Provider Services
“TRICARE” is a registered trademark of the TRICARE Management Activity. All rights reserved.
TriWest Healthcare Alliance provides access to quality
health care for 2.9 million members of America's military
family in the 21-state TRICARE West Region.
HO922010-8/3/2011
Register Today for the Secure Provider Portal TriWest Healthcare Alliance (TriWest) has a variety of online resources available on the secure
provider portal at TriWest.com/provider for network and non-network TRICARE providers. This
password protected website is intended to help enhance your experience in administratively
caring for TRICARE West Region beneficiaries.
Registered users can:
Verify patient eligibility
Research covered benefits and checking referral/authorization and medical review
requirements for specific codes
Submit referrals/authorizations online and check their status regardless of how the
request was submitted
Submit claims online and check claim status regardless of how the claim was submitted
Download remittance advices
Download claims status reports
Submit corrected claims
Claims correspondence/Webmail
To make the registration process as easy as possible, make sure you have the following
information available before you register:
Your tax ID number
One of the following:
o License number
o Medicare number
o NPI
One of the following:
o Two claim numbers (from TRICARE West-Region Claim remittance advices)
o Two authorization reference numbers
o One claim number and one reference number
You also need the date of birth of the beneficiary or beneficiaries from the internal claim
number (ICN) or reference number (You can use the same beneficiary for both or have two
different beneficiaries.)
The first person to register for the secure website is automatically the administrator. Administrators
can give access to additional users in their office.
If you don’t have the information needed to register for the secure website, you can call WPS
EDI at (800) 782-2680 for assistance.
TriWest Provider Services
“TRICARE” is a registered trademark of the TRICARE Management Activity. All rights reserved.
TriWest Healthcare Alliance provides access to quality
health care for 2.9 million members of America's military
family in the 21-state TRICARE West Region.
HO-46-2010-8/3/2011
Streamline Your Work: Use TriWest’s Secure Website
TriWest Healthcare Alliance (TriWest) offers the following online features on the secure provider
portal at TriWest.com/provider. To register and get instant access to your secure account, go to
the “Register Now” section of Triwest.com/provider.
TriWest has created several website demonstrations, which can be accessed in the Videos section
of Triwest.com/provider, demonstrating how to use the secure website to streamline your work.
Registered User Options Details
Verifying Patient Eligibility
From the Eligibility & Benefits area, view the patient’s TRICARE status,
Primary Care Manager history (if applicable), and details on eligibility,
other health insurance and out of pocket.
Research Benefits, Check
Referral/Authorization and
Medical Review
Requirements
In the West Region Benefit Lookup Tool, users enter the CPT or HCPCS
code and information about the patient. The tool will display benefit
exceptions, if applicable, based on search criteria.
Online
Referral/Authorization
Submission and Status
From the Referral and Authorization area, you will get an almost
immediate response to your online referral and authorization requests
in most cases. You can view the real-time status of your request online.
You also can view, download or print the requests from the referring
provider and the letters from TriWest.
Submit Claims and View
Claims Status Online
Under the Claims Center area, submit TRICARE West Region claims
(including secondary and corrected claims) online and receive an
immediate processing response. Most ”clean” claims are processed
within 24 hours. Use View Claim status to determine a claim’s status,
regardless of the submission method.
Download Remittance
Advices
Electronic Remittance Advice (ERA) is an electronic version of the
provider’s Remittance Advice and gives detailed financial information
regarding processed claims.
Download Provider Claims
Status Reports
This report provides financial information for all claims processed over
a four-week period. It can be printed, downloaded to an Excel
spreadsheet or viewed online.
Claims
Correspondence/Webmail
Registered users can use online claims correspondence for appeals,
claim check and claim reviews. Webmail allows users to submit
inquiries regarding their user profile that don’t necessarily require an
immediate resolution.
TriWest Provider Services
“TRICARE” is a registered trademark of the TRICARE Management Activity. All rights reserved.
TriWest Healthcare Alliance provides access to quality health care for 2.9 million
members of America's military family in the 21-state TRICARE West Region.
HO-54-2010-8/3/2011
TRICARE Programs Overview
TRICARE
Program
Description
Handbook Reference
TRICARE Prime
Managed care option defined by TRICARE Prime service
areas
Fewer out-of-pocket costs than other TRICARE options
Enrollment necessary
Beneficiaries have TRICARE enrollment card and Military ID
card
No copays for active duty Service members and active duty
family members unless using pharmacy or Point of Service
benefit
Copays for retirees and their families
Section 4,
pgs. 25-27
Section 6,
pgs. 60-61
TRICARE Prime
Remote (TPR),
TRICARE Prime
Remote for
Active Duty
Family Members
(TPRADFM)
Eligibility determined by military branch
Enrollment necessary
Beneficiaries have TRICARE ID enrollment card and Military ID
card
No copays unless using pharmacy or Point of Service benefit
TPR ZIP Code Look-Up Tool
http://www.tricare.mil/tpr/default_zip.cfm
Section 4,
pgs. 27-28;
Section 6,
pg. 60
TRICARE
Standard
Fee-for-service option
No enrollment required
Military ID cards used for eligibility determination
Deductible, cost-shares, catastrophic cap based on fiscal
year
Beneficiaries may seek care from any TRICARE-
certified/authorized provider
Section 4,
pg. 28;
Section 6,
pg. 62
TRICARE Extra
Preferred provider option
No enrollment required
TRICARE Standard beneficiaries can choose a doctor,
hospital, or other medical provider within the TriWest provider
network
Deductible, reduced cost-share
Section 4,
pg. 28;
Section 6,
pg. 62
TRICARE Reserve
Select (TRS)
TRICARE health plan similar to TRICARE Standard
Health care coverage for National Guard/Reserve members
who meet specific eligibility requirements
Section 4,
pgs. 34-35;
Section 6,
pg. 62
TRICARE Retired
Reserve (TRR)
TRICARE health plan similar to TRICARE Reserve Select
Qualified Members of the Retired Reserve may purchase
TRICARE Standard Coverage.
Section 4,
pgs. 35-36;
Section 6,
pg. 62
TRICARE Young
Adult
TRICARE health plan similar to TRICARE Standard/Extra (Prime
coming late 2011)
Covers eligible dependent of sponsor who is TRICARE-eligible
up to age 26
Need to meet specific criteria to be eligible
Monthly premiums
Not in West Region
Handbook; see
www.tricare.mil
TriWest Provider Services
“TRICARE” is a registered trademark of the TRICARE Management Activity. All rights reserved.
TriWest Healthcare Alliance provides access to quality health care for 2.9 million
members of America's military family in the 21-state TRICARE West Region.
HO-54-2010-8/3/2011
TRICARE
Program
Description
Handbook Reference
TRICARE For Life Serves as Medicare wraparound coverage for TRICARE
beneficiaries who are entitled to Medicare Part A and who
have Medicare Part B coverage
Administered by Wisconsin Physicians Service Insurance Corp.
(WPS), not TriWest
TFL pays after Medicare for covered health care services
Section 4,
pgs. 28-29
Extended Care
Health Option
(ECHO)
Provides additional healthcare coverage benefits to active
duty family members with special needs
Beneficiaries must qualify; based on specific mental or
physical disabilities
Offers integrated set of services and supplies beyond the
basic TRICARE programs
Section 4,
pgs. 37-39
Autism
Demonstration
Project
Enhances TRICARE Extended Care Health Option (ECHO)
program
Benefits available to children of active duty Service members Allows tutors and tutors-in-training supervised by an applied
behavior analysis (ABA) therapist to deliver EIA services to
eligible beneficiaries
Section 4,
pg. 39
Transitional
Assistance
Management
Program (TAMP)
Allows certain uniformed services members separated from
active duty service and their family members transitional
health care benefits
Eligibility determined by Department of Defense (DoD)
TRICARE coverage is available for 180 days
Sponsors separating from active duty and family members
enrolled in TRICARE Prime have to re-enroll to continue their
enrollment upon the sponsor’s separation from active duty
Section 4,
pgs. 41-42
Transitional Care
for Service-
Related
Conditions
Extends TRICARE coverage for qualified former active duty
Service members who are diagnosed with service-related
conditions during their 180-day Transitional Assistance
Management Program (TAMP) period
Covers care only for the specific service-related condition;
preventive and health maintenance care are not covered
No copayments or cost-shares
Section 4,
Pg. 42
Continued
Health Care
Benefit Program
(CHCBP)
Provides transitional benefits for a specified period of time
(18–36 months) to former service members and their families,
some unremarried former spouses, and emancipated
children (living on their own)
Administered by Humana Military Healthcare Services, Inc.
Section 4,
pg. 41
Dental Program
Voluntary dental insurance program
Available to eligible active duty family members (ADFMs),
Selected Reserve and Individual Ready Reserve (IRR)
members, and their eligible family members
Premium required for coverage
Section 4,
pg. 33;
Section 5,
pgs. 44-45
Retiree Dental
Program
Voluntary dental insurance program
Dental coverage for uniformed services retirees and their
eligible family members, certain surviving family members of
deceased active duty sponsors, and Medal of Honor
Section 4,
pg. 33
TriWest Provider Services
“TRICARE” is a registered trademark of the TRICARE Management Activity. All rights reserved.
TriWest Healthcare Alliance provides access to quality health care for 2.9 million
members of America's military family in the 21-state TRICARE West Region.
HO-54-2010-8/3/2011
TRICARE
Program
Description
Handbook Reference
recipients and their immediate family members and survivors
Premium required for coverage
Pharmacy
Program
Includes Medicare-eligible beneficiaries age 65 and over
who can have a written prescription filled using any of these
pharmacy options:
MTF pharmacies
TRICARE Retail Network Pharmacy
TRICARE Pharmacy Home Delivery
Non-network pharmacies
Note: Filling prescriptions in non-network pharmacies is the
most expensive option
Home delivery and retail network pharmacy services
administered by Express Scripts Inc. (ESI)
Section 4,
pgs. 29-33
TRICARE Plus Allows beneficiaries who normally are only able to get care
at an MTF on a space-available basis to enroll and receive
primary care appointments within same access standards as
TRICARE Prime beneficiaries
Only available at certain MTFs
Not a health plan, just a way to access primary care at an
MTF
Not in West Region
Handbook; see
www.tricare.mil
US Family Health
Plan (USFHP)
A TRICARE Prime option
Offered in six geographic regions in the United States
Separately funded program, different from TRICARE
Section 8,
Pg. 106-107
Military
OneSource
(Not a TRICARE
program)
Provides information ranging from every day concerns to
deployment/reintegration issues for active duty, Reserve, and
National Guard military members and their families, and
deployed DoD civilians and their families
24-7, toll free information and referral telephone service
available worldwide; from the U.S.: 1-800-342-9647
Online services available at www.militaryonesource.com.
No cost for Military OneSource services
Not in West Region
Handbook; see
MilitaryOneSource.com
Supplemental
Health Care
Program (SHCP)
(Not a TRICARE
program)
Different payment source for active duty Service members
(except those enrolled in TPR) and non-active duty
individuals under certain conditions when referred to civilian
providers for service related to injuries or treatments
Enrollment not required
Administered by MTF Command
Submit claims same as for West Region
Section 4,
pgs. 39-41