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Breadcrumb component - --> 284 </div> 285 286 287 288 289 </nucleus-hero> 290 291</div> 292<div class="richText text"> 293<div data-cmp-data-layer="{"20260918-ClaimPayPause":{"xdm:text":"&nbsp; &nbsp;","@type":"humana-military-com/components/richText","@id":"20260918-ClaimPayPause","repo:modifyDate":"2026-09-18T15:28:48Z"}}" id="20260918-ClaimPayPause" class="cmp-text"> 294 <p>  </p> 295 296</div> 297 298 299 300</div> 301<div class="card"> 302 303 304<div class="mi-article-cards__wrapper mi-article-fixed-cards "> 305 <div class="mi-article-cards__img-wrap"> 306 <img/> 307 </div> 308 <div class="mi-article-cards__content-txt"> 309 <h3 class="mi-article-cards__content-txt-title"> 310 Claim payment pause during fiscal year 2026 to 2027 changeover 311 </h3> 312 <div class="mi-article-cards__content-txt-eyebro-txt"> September 18, 2026</div> 313 <p>Due to the end of the fiscal year, claim payments will be paused between September 23-September 30, 2026. Providers may experience a brief payment delay of up to one week during this transition.</p> 314<p> </p> 315<p>Key dates to remember:</p> 316<p> </p> 317<p>September 27: The final payment cycle for FY26 claims will be mailed.</p> 318<p> </p> 319<p>October 1: The first payment of FY27 will be reviewed for accuracy and released if no issues are identified.</p> 320<p> </p> 321<p>October 5: Payments requiring Defense Health Agency approval may be delayed until this date.</p> 322 323 </div> 324 <div class="mi-article-cards__content-cta-wrap"> 325 <div slot="cta"> 326 327 328 329 </div> 330 </div> 331</div></div> 332<div class="richText text"> 333<div data-cmp-data-layer="{"20260901-ABA":{"xdm:text":"&nbsp; &nbsp;","@type":"humana-military-com/components/richText","@id":"20260901-ABA","repo:modifyDate":"2026-08-26T18:45:31Z"}}" id="20260901-ABA" class="cmp-text"> 334 <p>  </p> 335 336</div> 337 338 339 340</div> 341<div class="card"> 342 343 344<div class="mi-article-cards__wrapper "> 345 <div class="mi-article-cards__img-wrap"> 346 <img/> 347 </div> 348 <div class="mi-article-cards__content-txt"> 349 <h3 class="mi-article-cards__content-txt-title"> 350 TRICARE Plus: What civilian specialty care providers need to know 351 </h3> 352 <div class="mi-article-cards__content-txt-eyebro-txt"> September 2, 2026</div> 353 <p>Civilian specialty care providers may see <b>TRICARE Plus</b> listed in a beneficiaryâs eligibility record. <b>TRICARE Plus is not a TRICARE insurance benefit; itâs a program that gives its enrollees access to primary care services</b> at their military hospital or clinic. The local military hospital or clinic manages enrollment, not Humana Military.</p> 354<p> </p> 355<p><b>Beneficiaries enrolled in TRICARE Plus arenât eligible for specialty care from civilian specialists under TRICARE Plus alone*</b>. Before providing civilian specialty services, verify whether the beneficiary has other coverage and follow the referral and coverage guidelines for specialty care. Examples of other coverage include TRICARE Select, TRICARE For Life, Medicare or other health insurance. </p> 356<p> </p> 357<p><b>TRICARE Plus status alone does not confirm that services are authorized or covered for payment.</b></p> 358<p> </p> 359<p>*If a patient is enrolled in both TRICARE Plus and TRICARE Select, civilian specialty care received off base is processed under TRICARE Select rules. (HDCP codes 347 and 348 denote this dual-enrollment coverage.)</p> 360<p> </p> 361<p>Learn more about <a data-ispdf="false" data-iscta="false" href="https://tricare.mil/Plans/SpecialPrograms/Plus">TRICARE Plus</a>. </p> 362<p> </p> 363<p>Source: <a data-ispdf="false" data-iscta="false" href="https://manuals.dha.mil/View-Publication/TOT5/FileName/C24S21?referenceDate=2026-08-19&bookmark=%23FM">TRICARE Operations Manual (TOM) Ch. 24 Sec. 21 (Change 155, Dec 10, 2025)</a>.</p> 364 365 </div> 366 <div class="mi-article-cards__content-cta-wrap"> 367 <div slot="cta"> 368 369 370 371 </div> 372 </div> 373</div></div> 374<div class="richText text"> 375<div data-cmp-data-layer="{"20260901-ABA":{"xdm:text":"&nbsp; &nbsp;","@type":"humana-military-com/components/richText","@id":"20260901-ABA","repo:modifyDate":"2026-08-26T18:45:31Z"}}" id="20260901-ABA" class="cmp-text"> 376 <p>  </p> 377 378</div> 379 380 381 382</div> 383<div class="card"> 384 385 386<div class="mi-article-cards__wrapper "> 387 <div class="mi-article-cards__img-wrap"> 388 <img/> 389 </div> 390 <div class="mi-article-cards__content-txt"> 391 <h3 class="mi-article-cards__content-txt-title"> 392 Annual audit reminder for autism providers 393 </h3> 394 <div class="mi-article-cards__content-txt-eyebro-txt"> September 1, 2026</div> 395 <p>As part of TRICARE requirements, all Autism Care Demonstration (ACD) providers must participate in an annual audit. Even if your audit is still months away, now is a great time to make sure your records are organized and up-to-date.</p> 396<p> </p> 397<p>Staying on top of documentation throughout the year can help make the process smoother when your audit comes around.</p> 398<p> </p> 399<p>For details, see the <a href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2024-05-30/AsOf/TOT5/C18S3.html">TRICARE Operations Manual (TOM), Ch. 18, Sec. 3, 8.9.2</a>, which states that the contractor shall conduct an annual audit of each Autism Corporate Service Provider (ASCP)/sole provider group. This includes a minimum of 30 records consisting of administrative and medical documentation reviews and one Medical Team Conference (MTC) session note.</p> 400<p> </p> 401<p>For full audit requirements and preparation requirements, please see <a title="https://manuals.health.mil/" href="https://manuals.health.mil/">
401TRICARE Manuals - Home</a>.</p> 402 403 </div> 404 <div class="mi-article-cards__content-cta-wrap"> 405 <div slot="cta"> 406 407 408 409 </div> 410 </div> 411</div></div> 412<div class="richText text"> 413<div data-cmp-data-layer="{"text-749ebd7d8f":{"xdm:text":"&nbsp; &nbsp;","@type":"humana-military-com/components/richText","@id":"text-749ebd7d8f","repo:modifyDate":"2026-08-26T14:40:31Z"}}" id="richText-749ebd7d8f" class="cmp-text"> 414 <p>Â Â </p> 415 416</div> 417 418 419 420</div> 421<div class="card"> 422 423 424<div class="mi-article-cards__wrapper "> 425 <div class="mi-article-cards__img-wrap"> 426 <img/> 427 </div> 428 <div class="mi-article-cards__content-txt"> 429 <h3 class="mi-article-cards__content-txt-title"> 430 Childbirth and Breastfeeding Support Demonstration extended through December 31, 2031 431 </h3> 432 <div class="mi-article-cards__content-txt-eyebro-txt"> August 21, 2026</div> 433 <p>TRICARE recently announced that the Childbirth and Breastfeeding Support Demonstration (CBSD) has been extended through December 31, 2031.</p> 434<p>Â </p> 435<p>This demonstration allows Certified Labor Doulas (CLD), lactation consultants or lactation counselors to provide care to eligible beneficiaries. This extension allows these beneficiaries to continue accessing childbirth and breastfeeding support services under the demonstration.</p> 436<p>Â </p> 437<p>No other changes regarding the demonstration are being announced at this time. Providers and beneficiaries should continue to follow current CBSD guidance and requirements.</p> 438<p>Â </p> 439<p>For more information, refer to the <a href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2026-08-19/AsOf/TOT5/C18S11.html" data-iscta="false" data-ispdf="false">TRICARE Operations Manual (TOM), Ch. 18, Sec. 11</a> and <a data-ispdf="false" data-iscta="false" href="https://www.humanamilitary.com/provider/resources/cbsd">Childbirth and Breastfeeding Support Demonstration (CBSD) page</a>.</p> 440 441 </div> 442 <div class="mi-article-cards__content-cta-wrap"> 443 <div slot="cta"> 444 445 446 447 </div> 448 </div> 449</div></div> 450<div class="richText text"> 451<div data-cmp-data-layer="{"text-6bd7e54a3c":{"xdm:text":"&nbsp; &nbsp;","@type":"humana-military-com/components/richText","@id":"text-6bd7e54a3c","repo:modifyDate":"2026-08-21T13:48:44Z"}}" id="richText-6bd7e54a3c" class="cmp-text"> 452 <p>Â Â </p> 453 454</div> 455 456 457 458</div> 459<div class="container responsivegrid"> 460 461 462 463 464 <div id="container-7fff1e4b4e" class="cmp-container"> 465 466 <div class="card"> 467 468 469<div class="mi-article-cards__wrapper "> 470 <div class="mi-article-cards__img-wrap"> 471 <img/> 472 </div> 473 <div class="mi-article-cards__content-txt"> 474 <h3 class="mi-article-cards__content-txt-title"> 475 Coverage updates for cardiovascular and dermatological procedures 476 </h3> 477 <div class="mi-article-cards__content-txt-eyebro-txt"> August 19, 2026</div> 478 <p>TRICARE recently updated its policy to add coverage to certain cardiovascular and dermatological procedures.<br /> 479<br /> 480</p> 481<p><b>Cardiovascular system</b><br /> 482<br /> 483TRICARE now includes coverage of ambulatory blood pressure monitoring (ABPM) for the following diagnoses:</p> 484<ul><li>White coat hypertension in adult and pediatric patients</li><li>Masked hypertension in adult and pediatric patients</li><li>Abnormal nocturnal blood pressure in pediatric patients or management of specific conditions in pediatric patients, as recommended by the American Academy of Pediatrics (AAP) or American Heart Association (AHA). Such conditions include:<ul><li>chronic kidney disease (CKD)</li><li>coarctation of the aorta</li><li>types I and II diabetes</li><li>obstructive sleep apnea (OSA) syndrome</li><li>genetic syndromes (e.g., Neurofibromatosis type 1, Turner syndrome, Williams syndrome)</li><li>pediatric patients receiving anti-hypertensive drug treatments</li><li>patients who are the recipient of a heart or kidney transplant</li></ul> 485</li></ul> 486<p>Â </p> 487<p><b>Dermatological procedures</b><br /> 488</p> 489<p><br /> 490Changes to the dermatological procedure include adding coverage for ablative fractional laser for the treatment of scars resulting from burns and other trauma. Care must be preauthorized, including any sessions past the first treatment, to ensure ongoing therapy remains medically necessary and appropriate for the treatment of symptomatic scars.<br /> 491</p> 492<p><br /> 493For more information about these updates, please refer to the <a href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2026-07-28/AsOf/TPT5/C4S9_1.html">TRICARE Policy Manual (TPM) Ch. 4, Sec. 9.1</a> and <a href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2026-07-28/AsOf/TPT5/C7S17_1.html">TPM Ch. 7, Sec. 17.1</a></p> 494 495 </div> 496 <div class="mi-article-cards__content-cta-wrap"> 497 <div slot="cta"> 498 499 500 501 </div> 502 </div> 503</div></div> 504<div class="richText text"> 505<div data-cmp-data-layer="{"text-6ca10f3009":{"xdm:text":"&nbsp; &nbsp;&nbsp;","@type":"humana-military-com/components/richText","@id":"text-6ca10f3009","repo:modifyDate":"2026-08-21T13:47:56Z"}}" id="richText-6ca10f3009" class="cmp-text"> 506 <p>Â Â Â </p> 507 508</div> 509 510 511 512</div> 513<div class="card"> 514 515 516<div class="mi-article-cards__wrapper "> 517 <div class="mi-article-cards__img-wrap"> 518 <img/> 519 </div> 520 <div class="mi-article-cards__content-txt"> 521 <h3 class="mi-article-cards__content-txt-title"> 522 Update to laser hair removal (LHR) referrals 523 </h3> 524 <div class="mi-article-cards__content-txt-eyebro-txt"> August 7, 2026</div> 525 <p>A recent update removes the requirement for dermatologists at military hospitals and clinics to review referrals to private sector dermatologists for laser hair removal (LHR) treatment of pseudofolliculitis barbae (PFB). Commonly known as razor bumps, PFB treatment with LHR is covered for active duty service members (ADSM), if criteria for coverage are met.</p> 526<p>Â </p> 527<p>Whatâs changed?</p> 528<p>Â </p> 529<p>The requirement for military medical dermatology review of referrals to private sector dermatologists is no longer required.</p> 530<p>Â </p> 531<p>What hasnât changed?</p> 532<p>Â </p> 533<p>ADSMs still need a referral, but a Primary Care Manager (PCM) can now make the referral to qualified dermatologists and physicians to perform these services for treatment for PHB with LHR when the criterion for coverage is met.</p> 534<p>Â </p> 535<p>For more information about the referral process and coverage for PFB, visit T-5 <a href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2026-07-31/AsOf/TOT5/C17S3.html">TRICARE Operations Manual (TOM), Ch. 17, Sec. 3, âLaser Therapy for Pseudofolliculitis Barbae
535(PFB) of the Face and Neck.â</a></p> 536 537 </div> 538 <div class="mi-article-cards__content-cta-wrap"> 539 <div slot="cta"> 540 541 542 543 </div> 544 </div> 545</div></div> 546<div class="richText text"> 547<div data-cmp-data-layer="{"20251006-VirtualHealthBilling":{"xdm:text":"&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;","@type":"humana-military-com/components/richText","@id":"20251006-VirtualHealthBilling","repo:modifyDate":"2026-08-07T19:56:04Z"}}" id="20251006-VirtualHealthBilling" class="cmp-text"> 548 <p>Â Â Â Â Â Â Â Â Â Â Â Â Â Â </p> 549 550</div> 551 552 553 554</div> 555<div class="card"> 556 557 558<div class="mi-article-cards__wrapper "> 559 <div class="mi-article-cards__img-wrap"> 560 <img/> 561 </div> 562 <div class="mi-article-cards__content-txt"> 563 <h3 class="mi-article-cards__content-txt-title"> 564 TRICARE 2026 inpatient daily charge and Diagnosis Related Group (DRG) updates 565 </h3> 566 <div class="mi-article-cards__content-txt-eyebro-txt"> August 3, 2026</div> 567 <p>Effective July 31, 2026, the Defense Health Agency (DHA) has implemented changes to the <a href="https://manuals.health.mil/pages/ManualToc.aspx?Manual=TRT5&Change=25"><i>TRICARE Reimbursement Manual</i><b> </b>(<i>TRM</i>)</a> related to (1) inpatient cost-shares for certain services rendered at military hospitals and clinics and (2) hospital reimbursement under the TRICARE DRG-based payment system.</p> 568<p>Â </p> 569<p>The updated policy reflects the 2026 âMilitary medical treatment facility daily charge amountâ for inpatient care. The daily charge for services received from January 1, 2026, through December 31, 2026, is $24.50. This daily charge applies to all inpatient services, including mental health and Substance Use Disorder (SUD) services. This applies to Active Duty Family Members (ADFM) or their sponsors.</p> 570<p>Â </p> 571<p>The policy change also updates the labor-related and non-labor-related portions of the Adjusted Standardized Amount (ASA) under the TRICARE DRG-based payment system. Effective January 1, 2026, for wage index values greater than 1.0, the labor-related portion is 66.0% and the non-labor-related portion is 34.0%. The wage index values less than or equal to 1.0 remains the same, with the labor-related portion at 62.0% and the non-labor-related portion at 38.0%.</p> 572<p>Â </p> 573<p>Providers should review the applicable <i>TRM</i> sections and ensure billing and reimbursement processes are updated to reflect these changes.</p> 574<p>Â </p> 575<p>Source: <i>TRM</i>, <a href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2026-06-30/AsOf/TRT5/C2S1.html">Ch. 2, Sec. 1</a> and <a href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2026-06-30/AsOf/TRT5/C6S7.html">Ch. 6, Section 7</a>.</p> 576 577 </div> 578 <div class="mi-article-cards__content-cta-wrap"> 579 <div slot="cta"> 580 581 582 583 </div> 584 </div> 585</div></div> 586<div class="richText text"> 587<div data-cmp-data-layer="{"text-65ad1f4f2f":{"xdm:text":"&nbsp; &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;","@type":"humana-military-com/components/richText","@id":"text-65ad1f4f2f","repo:modifyDate":"2026-08-07T19:55:17Z"}}" id="richText-65ad1f4f2f" class="cmp-text"> 588 <p>Â Â Â Â Â Â Â Â Â Â Â </p> 589 590</div> 591 592 593 594</div> 595<div class="card"> 596 597 598<div class="mi-article-cards__wrapper "> 599 <div class="mi-article-cards__img-wrap"> 600 <img/> 601 </div> 602 <div class="mi-article-cards__content-txt"> 603 <h3 class="mi-article-cards__content-txt-title"> 604 Requirement reminder for capped rental items 605 </h3> 606 <div class="mi-article-cards__content-txt-eyebro-txt"> July 2, 2026</div> 607 <p>Capped rental Durable Medical Equipment (DME) claims require the use of specific modifiers in sequential order for the first rental month and each subsequent month to ensure proper claim processing and payment.</p> 608<p>Â </p> 609<p>Please submit modifiers KH, KI, and KJ in the correct sequence. Missing or out-of-sequence modifiers may result in a claimâs denial.</p> 610<p>Â </p> 611<p>If any of these modifiers are not included, the claim will be denied, and a corrected claim must be resubmitted for processing.</p> 612<p>Â </p> 613<p>Visit <a data-iscta="false" data-ispdf="false" target="_self" href="https://www.humanamilitary.com/provider/claims/dme#nucleustabs-b092e433ff-item-5b45a4cb77-tab" rel="noopener noreferrer">DME rental vs. purchase</a> for more information.</p> 614 615 </div> 616 <div class="mi-article-cards__content-cta-wrap"> 617 <div slot="cta"> 618 619 620 621 </div> 622 </div> 623</div></div> 624<div class="richText text"> 625 626 627 628 629</div> 630<div class="card"> 631 632 633<div class="mi-article-cards__wrapper "> 634 <div class="mi-article-cards__img-wrap"> 635 <img/> 636 </div> 637 <div class="mi-article-cards__content-txt"> 638 <h3 class="mi-article-cards__content-txt-title"> 639 New guidance for Transcutaneous Electrical Nerve Stimulation (TENS) device coverage 640 </h3> 641 <div class="mi-article-cards__content-txt-eyebro-txt"> July 1, 2026</div> 642 <p>A TENS device is a small, wearable, battery-operated device that uses electrical impulses on the skin
642near painful areas of the body. TENS may be administered by a clinician in a hospital or outpatient setting or self-administered by a beneficiary at home. Over-the-counter devices are also available for purchase.<br /> 643 </p> 644<p>TRICARE recently added a new section to the TRICARE Policy Manual (TPM) that outlines coverage for Food and Drug Administration (FDA)-approved or FDA-cleared TENS devices and supplies for <b>acute post-operative pain, including coverage criteria, replacement supply limits and exclusions.<br /> 645  </b></p> 646<p><b>Coverage details</b></p> 647<ul><li>The initial TENS device authorization includes supplies and lead wires for the first 30-day rental period.</li><li>If pain continues beyond 30 days, cost-sharing of TENS devices requires monthly documentation of medical necessity by a TRICARE authorized provider, not to exceed 90 days (three one-month rentals) from the day of the surgery.</li><li>The device must be prescribed within the first 30 days of surgery.</li></ul> 648<p> </p> 649<p><b>Replacement supply limitations</b></p> 650<ul><li>Replacement supplies, such as electrodes, conductive paste/gel, batteries and batteries chargers, are covered only under procedure code A4595 which is an all-inclusive monthly supply allowance code and must not be unbundled.</li><li>Monthly replacement supply limits are:<ul><li>Two-lead TENS: maximum of one unit per month</li><li>Four-lead TENS: maximum of two units per month</li></ul> 651</li><li>Lead wire replacement may be covered during the 90-day rental when the wires are broken, not working and require replacement.</li><li>Conductive garments require medical justification and are covered only when specific criteria are met.<br /> 652 </li></ul> 653<p><b>Exclusions</b></p> 654<p>TENS devices and supplies are excluded from coverage for:</p> 655<ul><li>Home use when prescribed during physical therapy for acute, subacute, or chronic low back pain, effective June 1, 2020</li><li>Chronic post-operative pain, effective July 1, 2026</li><li>Any condition other than acute post operative pain under the policy, effective July 1, 2026<br /> 656 </li></ul> 657<p>For full coverage criteria and additional details, see <a href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2026-06-10/AsOf/TPT5/C8S20_2.html">TPM Ch. 8, Sec. 20.2</a> for more information. </p> 658 659 </div> 660 <div class="mi-article-cards__content-cta-wrap"> 661 <div slot="cta"> 662 663 664 665 </div> 666 </div> 667</div></div> 668<div class="richText text"> 669<div data-cmp-data-layer="{"20260630-PRS":{"xdm:text":"&nbsp; &nbsp; &nbsp;","@type":"humana-military-com/components/richText","@id":"20260630-PRS","repo:modifyDate":"2026-06-30T20:16:27Z"}}" id="20260630-PRS" class="cmp-text"> 670 <p>   </p> 671 672</div> 673 674 675 676</div> 677<div class="card"> 678 679 680<div class="mi-article-cards__wrapper "> 681 <div class="mi-article-cards__img-wrap"> 682 <img/> 683 </div> 684 <div class="mi-article-cards__content-txt"> 685 <h3 class="mi-article-cards__content-txt-title"> 686 Provider resource spotlight: Tools to help reduce and resolve claims issues 687 </h3> 688 <div class="mi-article-cards__content-txt-eyebro-txt"> June 30, 2026</div> 689 <p>Navigating the claims process can be complex, but Humana Militaryâs online tools are here to make it easier. Providers and administrative staff can access helpful resources organized by each step of the claims journeyâsaving time and finding answers faster. Explore the sections below to discover solutions tailored to your needs throughout the claimâs lifecycle.</p> 690<p> </p> 691<p><b>Verifying eligibility and benefits</b></p> 692<p>You can check patient eligibility and benefits using two methods: physical ID cards and virtually through <a href="https://infocenter.humana-military.com/prov/service/Account/Login" target="_blank" data-ispdf="false" data-iscta="false" rel="noopener noreferrer">provider self-service</a>.</p> 693<p> </p> 694<p>For examples of acceptable ID cards, including Common Access Card (CAC) or other government-issued ID cards, <a href="https://www.humanamilitary.com/provider/resources/eligibility" target="_self" data-ispdf="false" data-iscta="false" rel="noopener noreferrer">look at samples</a> on the eligibility web page.</p> 695<p> </p> 696<p>Have questions? Review this concise <a href="https://www.humanamilitary.com/content/dam/sites/humana-military-com/provider/faqs/prov
696ider-eligibility-faqs.pdf" target="_blank" data-ispdf="true" data-iscta="false" rel="noopener noreferrer">provider eligibility FAQ</a>.</p> 697<p> </p> 698<p><b>Assigning codes and code updates</b></p> 699<p>You may use the CPT code look-up in <a href="https://infocenter.humana-military.com/prov/service/Account/Login" target="_blank" data-ispdf="false" data-iscta="false" rel="noopener noreferrer"> provider self-service</a> to verify referral and prior authorization requirements. Have questions about hospital billing or how to bill for multiple procedures? Chapter 10 of the <a href="https://www.humanamilitary.com/content/dam/sites/humana-military-com/provider/tricare-provider-handbook.pdf" target="_blank" data-ispdf="true" data-iscta="false" rel="noopener noreferrer"><i>Humana Military Provider Handbook</i></a> covers useful, straightforward claims and billing information. It has also an easy reference chart for <a href="https://www.humanamilitary.com/content/dam/sites/humana-military-com/provider/tipsheets/autism_tipsheets/CPT-Codes.pdf" target="_blank" data-ispdf="true" data-iscta="false" rel="noopener noreferrer">Applied Behavior Analysis (ABA) CPT codes</a>.</p> 700<p> </p> 701<p>CPT codes are subject to periodic updates and revisions. Providers are responsible for using the correct codes when submitting claims. Humana Military is committed to proactively communicating any policy changes involving CPT codes, like a recent article on <a href="https://www.humanamilitary.com/provider/resources/news#20250302-claimsdenialsVHS" target="_self" data-ispdf="false" data-iscta="false" rel="noopener noreferrer">virtual health billing</a>.</p> 702<p> </p> 703<p>To stay informed, check <a href="https://www.humanamilitary.com/provider/resources/news" target="_self" data-ispdf="false" data-iscta="false" rel="noopener noreferrer">provider news and updates</a> regularly for updates and clarifications on codes.</p> 704<p> </p> 705<p><b>Completing a compliant form and submission</b></p> 706<p>TRICARE requires network providers to file claims electronically with the appropriate HIPAA-compliant, standard, electronic claims format using <a href="https://infocenter.humana-military.com/prov/service/Account/Login" target="_blank" data-ispdf="false" data-iscta="false" rel="noopener noreferrer">provider self-service</a> or with a clearinghouse. View <a href="https://www.humanamilitary.com/provider/claims" target="_self" data-ispdf="false" data-iscta="false" rel="noopener noreferrer">instructions for using a clearinghouse</a>.</p> 707<p> </p> 708<p>Check out this <a href="https://www.humanamilitary.com/content/dam/sites/humana-military-com/provider/XPress-Claim-Guide.pdf" target="_blank" data-ispdf="true" data-iscta="false" rel="noopener noreferrer">electronic claims submission tutorial </a>to walk you through the process.</p> 709<p> </p> 710<p>Non-network providers may submit paper claims with a compliant <a href="https://www.cms.gov/medicare/billing/electronicbillingeditrans/1500" target="_blank" data-ispdf="true" data-iscta="false" rel="noopener noreferrer"><i>CMS-1500</i> (professional charge)</a> or a <a href="https://www.cms.gov/medicare/coding-billing/electronic-billing/institutional-paper-claim-form" target="_blank" data-ispdf="true" data-iscta="false" rel="noopener noreferrer"><i>UB-04</i> (institutional charge)</a>.</p> 711<p> </p> 712<p>Avoid delays in processing and reduce errors; donât use forms that are scanned, copied, regenerated or created in-house. For more details, view <a href="https://www.humanamilitary.com/provider/resources/news#202605120-CompliantClaimsForms" target="_self" data-ispdf="false" data-iscta="false" rel="noopener noreferrer">âAvoid claim processing delays: Use compliant forms.â</a></p> 713<p> </p> 714<p><b>Reimbursement and billing</b></p> 715<p>Get paid faster with Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA). When enrolled in EFT/ERA, providers typically receive payments within 24 hours of approval. This is significantly quicker than mailed checks, which may take up to two weeks longer.</p> 716<p> </p> 717<p><a href="https://www.humanamilitary.com/content/dam/sites/humana-military-com/provider/forms/miscellaneous/eft-and-era-enrollment-package.pdf" target="_blank" data-ispdf="false" data-iscta="false" rel="noopener noreferrer">Sign up for EFT/ERA today</a>.</p> 718<p> </p> 719<p><b>Appeals</b></p> 720<p>If a claim is denied, the provider can correct errors, provide documentation and <a href="https://infocenter.humana-military.com/prov/service/Account/Login" target="_blank" data-ispdf="false" data-iscta="false" rel="noopener noreferrer">resubmit the claims provider self-service</a>.</p> 721<p> </p> 722<p>If a claim is denied as a non-covered benefit or not medically necessary, a provider can appeal the claim. Check out this <a href="https://www.humanamilitary.com/appeal" target="_self" data-ispdf="false" data-iscta="false" rel="noopener noreferrer">appeals page</a> for more details and for a full list of who can submit an appeal.</p> 723<p> </p> 724<p>Have more questions about appeals? View the <a href="https://www.humanamilitary.com/content/dam/sites/humana-military-com/provider/faqs/appeal-submission-process-faqs.pdf" target="_blank" data-ispdf="false" data-iscta="false" rel="noopener noreferrer">appeal submission process FAQs</a> for answers!  </p> 725 726 </div> 727 <div class="mi-article-cards__content-cta-wrap"> 728 <div slot="cta"> 729 730 731 732 </div> 733 </div> 734</div></div> 735<div class="richText text"> 736<div data-cmp-data-layer="{"20260615-ESRD":{"xdm:text":"&nbsp; &nbsp; &nbsp;","@type":"humana-military-com/components/richText","@id":"20260615-ESRD","repo:modifyDate":"2026-06-15T16:20:20Z"}}" id="20260615-ESRD" class="cmp-text"> 737 <p>   </p> 738 739</div> 740 741 742 743</div> 744<div class="card"> 745 746 747<div class="mi-article-cards__wrapper "> 748 <div class="mi-article-cards__img-wrap"> 749 <img/> 750 </div> 751 <div class="mi-article-cards__content-txt"> 752 <h3 class="mi-article-cards__content-txt-title"> 753 End state renal disease (ESRD) reimbursement rate correction 754 </h3> 755 <div class="mi-article-cards__content-txt-eyebro-txt"> June 15, 2026</div> 756 <p>TRICARE reimburses freestanding ESRD facilities using a flat, per-session prospective payment system, modeled after Medicare. TRICARE updates its reimbursement rates annually to reflect current guidelines and cost data.</p> 757<p> </p> 758<p>Effective, Jan. 1, 2025, TRICARE updated the ESRD reimbursement rates for calendar year 2025. To view the updated 2025 rates, refer to the <a data-iscta="false" data-ispdf="false" target="_blank" href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2026-05-15/AsOf/TRT5/C19S1.html" rel="noopener noreferrer">TRICARE Reimbursement Manual (TRM), Ch. 19, Sec. 1</a>.</p> 759<p> </p> 760<p>Additionally, TRICARE has announced that beginning calendar year 2026, annual ESRD rate updates will no longer be published in the TRICARE manuals. Instead, these updates will continue to be available on the <a></a><a target="_blank" href="https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement/Freestanding-End-Stage-Renal-Disease-ESRD-Facility-Reimbursement-Rates" data-iscta="false" data-ispdf="false" rel="noopener noreferrer">TRICARE website</a>.</p> 761 762 </div> 763 <div class="mi-article-cards__content-cta-wrap"> 764 <div slot="cta"> 765 766 767 768 </div> 769 </div> 770</div></div> 771<div class="richText text"> 772<div data-cmp-data-layer="{"20260611-NoEstablishedRates":{"xdm:text":"&nbsp; &nbsp; &nbsp;","@type":"humana-military-com/components/richText","@id":"20260611-NoEstablishedRates","repo:modifyDate":"2026-06-11T18:00:17Z"}}" id="20260611-NoEstablishedRates" class="cmp-text"> 773 <p>   </p> 774 775</div> 776 777 778 779</div> 780<div class="card"> 781 782 783<div class="mi-article-cards__wrapper "> 784 <div class="mi-article-cards__img-wrap"> 785 <img/> 786 </div> 787 <div class="mi-article-cards__content-txt"> 788 <h3 class="mi-article-cards__content-txt-title"> 789 Document clarification and expanded guidance: Reimbursement for services or items without established rates 790 </h3> 791 <div class="mi-article-cards__content-txt-eyebro-txt"> June 11, 2026</div> 792 <p><i>Following our initial announcement on September 12, 2024, regarding reimbursement for services or items without established rates, we have received several questions from providers. This article offers further clarification on required documentation, including examples of acceptable and unacceptable submissions, and additional billing instructions. Please review the exp
792anded guidance below to ensure your claims are processed accurately.</i></p> 793<p> </p> 794<p>TRICARE updated its policy to initiate payment thresholds for services without established rates, including professional ones and Durable Medical Equipment, Prosthetics, Orthotics and Supplies/Parenteral and Enteral Nutrition (DMEPOS/PEN). This policy provides guidelines for determining appropriate reimbursement for these circumstances.</p> 795<p> </p> 796<p>Effective August 19, 2024, providers must submit additional documentation with claims for dates of service on or after June 13, 2022. The following must be included with claim submissions:</p> 797<ul><li><b><u>Description:</u></b> Narrative description of the service or item</li><li><b><u>Comparable code:</u></b> A comparable procedure code, if applicable. This code represents a recognized procedure with similar complexity, time and intensity to the unlisted service helping payers determine the appropriate value. Include documentation for any complicating factors or extenuating circumstances.</li><li><b><u>Supplier price list (SPL) / Manufacturer suggested retail price (MSRP):</u></b> The supplierâs price list amounts for Durable Medical Equipment (DME) and supply codes, as applicable:<ul><li>This documentation should be from the manufacturer and include contact information, the types of supplies or equipment provided (e.g., wheelchairs, oxygen, instruments), and the manufacturerâs suggested retail prices for the items.</li></ul> 798</li><li><b><u>Unacceptable documentation:</u></b><ul><li>Quotes from the billing provider</li><li>Documents labeled as âdelivery ticketâ from the billing provider</li><li>Handwritten alterations to the invoice (e.g., crossing out prices)</li><li>Invoices typed on the billing companyâs own letterhead rather than the manufacturers</li></ul> 799</li><li><b><u>Additional information:</u></b><ul><li>If the billing company is also the manufacturer of the item, the submitted DME claim must include either verbiage or support documentation, clearly identifying the company as the manufacturer.</li></ul> 800</li><li><b><u>Drug/Item information:</u></b> National Drug Code (NDC) dosage units and method of administration for drug codes (as applicable)</li><li><b><u>Units:</u></b> For DME claims, equipment cannot be submitted on the same claim line unless all of the following elements are identical:<ul><li>The equipment is the same make and model.</li><li>The billing code (such as the HCPCS code) is the same.</li><li>The SPL, MSRP and manufacturer suggested price (MSP) are all the same.</li></ul> 801</li></ul> 802<p><b> </b></p> 803<p><b>Additional tips and guidance:  </b></p> 804<ul><li>If any of these details differ, such as whether the equipment is different or the codes or amounts vary, each item must be billed on a separate line. This ensures accurate processing and payment.</li><li>In addition, you may be asked to provide additional documentation or justification to support the use of procedure codes categorized as unlisted, miscellaneous or not otherwise classified.</li><li>Payment thresholds established under this guidance will only be used until a TRICARE fee schedule or state prevailing rate has been established. </li><li>The policy applies to either network or non-network providers.</li></ul> 805<p> </p> 806<p>For more information, visit <a href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2026-05-15/AsOf/TRT5/C1ADE.html" target="_blank" data-ispdf="false" data-iscta="false" rel="noopener noreferrer"><b>TRICARE Reimbursement Manual (TRM), Ch. 1, Addendum E</b></a>. </p> 807 808 </div> 809 <div class="mi-article-cards__content-cta-wrap"> 810 <div slot="cta"> 811 812 813 814 </div> 815 </div> 816</div></div> 817<div class="richText text"> 818<div data-cmp-data-layer="{"20260528-CodingUpdate":{"xdm:text":"&nbsp; &nbsp; &nbsp;","@type":"humana-military-com/components/richText","@id":"20260528-CodingUpdate","repo:modifyDate":"2026-05-28T17:59:04Z"}}" id="20260528-CodingUpdate" class="cmp-text"> 819 <p>   </p> 820 821</div> 822 823 824 825</div> 826<div class="card"> 827 828 829<div class="mi-article-cards__wrapper "> 830 <div class="mi-article-cards__img-wrap"> 831 <img/> 832 </div> 833 <div class="mi-article-cards__content-txt"> 834 <h3 class="mi-article-cards__content-txt-title"> 835 Coding updates for Augmentative Communication Devices (ACD) 836 </h3> 837 <div class="mi-article-cards__content-txt-eyebro-txt"> May 28, 2026</div> 838 <p>TRICARE has updated miscellaneous CPT codes for Augmentative Communication Devices (ACD). As part of this update, CPT code 97608 has been removed from the approved list, while CPT code 92609 has been added.</p> 839<p><br /> 840ACDs, also referred to as Speech Generating Devices (SGD), are covered by TRICARE when they are medically necessary. These devices, along with medically necessary services and supplies help individuals who have severe speech impairments with the ability to meet functional speaking needs. ACDs/SGDs are characterized as speech devices intended solely for use by individuals with severe speech impairments.</p> 841<p><br /> 842For more information about this covered benefit, see <a data-ispdf="false" data-iscta="false" href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2026-04-28/ChangeO
842nly/TPT5/C7S23_1.html" target="_blank" rel="noopener noreferrer">TRICARE Policy Manual (TPM), Ch. 7, Sec. 23.1</a>.  </p> 843 844 </div> 845 <div class="mi-article-cards__content-cta-wrap"> 846 <div slot="cta"> 847 848 849 850 </div> 851 </div> 852</div></div> 853<div class="richText text"> 854<div data-cmp-data-layer="{"202605120-CompliantClaimsForms":{"xdm:text":"&nbsp; &nbsp; &nbsp;","@type":"humana-military-com/components/richText","@id":"202605120-CompliantClaimsForms","repo:modifyDate":"2026-05-20T20:10:37Z"}}" id="202605120-CompliantClaimsForms" class="cmp-text"> 855 <p>   </p> 856 857</div> 858 859 860 861</div> 862<div class="card"> 863 864 865<div class="mi-article-cards__wrapper "> 866 <div class="mi-article-cards__img-wrap"> 867 <img/> 868 </div> 869 <div class="mi-article-cards__content-txt"> 870 <h3 class="mi-article-cards__content-txt-title"> 871 Avoid claim processing delays: Use compliant claims forms 872 </h3> 873 <div class="mi-article-cards__content-txt-eyebro-txt"> May 20, 2026</div> 874 <p>TRICARE requires network providers to file claims electronically with the appropriate HIPAA-compliant, standard, electronic claims format using <a href="https://infocenter.humana-military.com/prov/service/Account/Login" target="_blank" data-ispdf="false" data-iscta="false" rel="noopener noreferrer">provider self-service</a> or with a clearinghouse. Non-network providers may submit paper claims with a compliant <a href="https://www.cms.gov/medicare/billing/electronicbillingeditrans/1500" target="_blank" data-ispdf="false" data-iscta="false" rel="noopener noreferrer"><i>CMS-1500</i> (professional charge)</a> or a <a href="https://www.cms.gov/medicare/coding-billing/electronic-billing/institutional-paper-claim-form" target="_blank" data-ispdf="false" data-iscta="false" rel="noopener noreferrer"><i>UB-04</i> (institutional charge)</a>.</p> 875<p> </p> 876<p>You may <a href="https://www.nubc.org/nubc-resources">purchase official claim forms</a> directly from the National Uniform Billing Committee (NUBC), who designs and maintains the official claim forms. However, the official forms can be purchased from the U.S. Government Printing Office, online and at local office supply stores. All TRICARE-authorized providers are strongly encouraged to take advantage of faster claims processing by submitting electronic claims. </p> 877<p> </p> 878<p>Avoid delays in processing and reduce errors; donât use forms that are scanned, copied, regenerated or created in-house. These often do not meet specifications and during the automated review, are found to be non-compliant. If this happens, the claims review is slowed down for a manual review, or the claims are rejected.</p> 879<p> </p> 880<p>To ensure accuracy and processing speed, claim forms must:</p> 881<ul><li> Be HIPPA compliant</li><li> Maintain proper structure within margins </li><li> Use the official red tone of the official form (recreated versions will not accurately represent colors in the form)</li></ul> 882 883 </div> 884 <div class="mi-article-cards__content-cta-wrap"> 885 <div slot="cta"> 886 887 888 889 </div> 890 </div> 891</div></div> 892<div class="richText text"> 893<div data-cmp-data-layer="{"202605120-GoElectronic":{"xdm:text":"&nbsp; &nbsp; &nbsp;","@type":"humana-military-com/components/richText","@id":"202605120-GoElectronic","repo:modifyDate":"2026-05-20T20:08:10Z"}}" id="202605120-GoElectronic" class="cmp-text"> 894 <p>   </p> 895 896</div> 897 898 899 900</div> 901<div class="card"> 902 903 904<div class="mi-article-cards__wrapper "> 905 <div class="mi-article-cards__img-wrap"> 906 <img/> 907 </div> 908 <div class="mi-article-cards__content-txt"> 909 <h3 class="mi-article-cards__content-txt-title"> 910 Maximize the speed of claims processing! Go electronic! 911 </h3> 912 <div class="mi-article-cards__content-txt-eyebro-txt"> May 20, 2026</div> 913 <p>Want to accelerate the processing and payment time of your claims? Enroll in electronic claims processing!</p> 914<p> </p> 915<p>The benefits of submitting through Electronic Data Interchange (EDI) are:</p> 916<ul><li><b>Accelerated processing:</b> EDI claims are processed on average within eight daysâapproximately 50% faster than paper submissions, which typically require 15 days.</li><li><b>Instant submission confirmation:</b> Receive immediate confirmation of your claim submission through Xpress Claims, eliminating uncertainty.</li><li><b>Minimized risk of misrouted claims:</b> EDI reduces errors associated with manual handling.</li><li><b>Efficient documentation management:</b> Attach supporting documents directly to EDI submissions, streamlining the review process and further reducing turnaround time.</li><li><b>Real-time status tracking: </b>Access provider self-service tools to monitor claim status, enabling quicker issue resolution compared to waiting up to 17 days for mailed notifications.</li><li><b>Faster payments with EFT/ERA:</b> When enrolled in Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA), providers typically receive payments within 24 hours of approval. This is significantly quicker than mailed checks, which may take up to two weeks longer.</li></ul> 917<p> </p> 918<p>If you donât have a clearinghouse, you can submit your claims with Xpress Claims through <a href="https://infocenter.humana-military.com/prov/service/Account/Login" target="_blank" data-ispdf="false" data-iscta="false" rel="noopener noreferrer">provider self-service</a>. If you do  have a clearinghouse, follow <a href="https://www.humanamilitary.com/contact/submissions/submit-claim-documents" target="_self" data-ispdf="false" data-iscta="false" rel="noopener noreferrer">these instructions</a>. Check out this <a href="https://www.humanamilitary.com/content/dam/sites/humana-military-com/provider/XPress-Claim-Guide.pdf" target="_blank" data-ispdf="true" data-iscta="false" rel="noopener noreferrer">electronic claims submission tutorial to walk you through the process</a>.</p> 919 920 </div> 921 <div class="mi-article-cards__content-cta-wrap"> 922 <div slot="cta"> 923 924 925 926 </div> 927 </div> 928</div></div> 929<div class="richText text"> 930<div data-cmp-data-layer="{"20260515-OrgAcqUpdates":{"xdm:text":"&nbsp; &nbsp; &nbsp;","@type":"humana-military-com/components/richText","@id":"20260515-OrgAcqUpdates","repo:modifyDate":"2026-05-15T17:16:20Z"}}" id="20260515-OrgAcqUpdates" class="cmp-text"> 931 <p>   </p> 932 933</div> 934 935 936 937</div> 938<div class="card"> 939 940 941<div class="mi-article-cards__wrapper "> 942 <div class="mi-article-cards__img-wrap"> 943 <img/> 944 </div> 945 <div class="mi-article-cards__content-txt"> 946 <h3 class="mi-article-cards__content-txt-title"> 947 Organ acquisition rates request update 948 </h3> 949 <div class="mi-article-cards__content-txt-eyebro-txt"> May 15, 2026</div> 950 <p>Effective Oct. 28, 2019, TRICARE offers reimbursement for reasonable and necessary organ acquisition services and costs in support of quality organ transplant programs. Under Medicare, Certified Transplant Centers (CTC) and Organ Procurement Organizations (OPO) report these costs using the <i>Centers for Medicare and Medicaid Services (CMS) Forms 2552 and 216</i>. TRICARE will use the Medicare Standard Acquisition Charges (SAC) to determine reimbursement amounts.</p> 951<p> </p> 952<p>Humana Military is tasked each year with surveying all hospitals that had an organ acquisition cost and providing this information to the Defense Health Agency (DHA) for the TRICARE East Region.</p> 953<p> </p> 954<p>To remain compliant, providers should return the following documents before July 31, 2026:</p> 955<ul><li>A completed <a href="https://www.humanamilitary.com/content/dam/sites/humana-military-com/provider/forms/miscellaneous/standard-acquisition-charges-sac-for-organ-acquisition.pdf" target="_blank" data-ispdf="true" data-iscta="false" rel="noopener noreferrer"><b>Standard Acquisition Charges (SAC) for organ acquisition form</b></a></li><li>The most recent SAC rate reported to Medicare</li></ul> 956<p> </p> 957<p>Please use the form referenced above and <b>do not submit D-4 worksheets</b>.</p> 958<p> </p> 959<p><b>There may be multiple facilities in your healthcare system. Please fill out one form for each facility or affiliated CTC based on the individual facilityâs physical address. It is important that you verify each facilityâs address and organ are included on the CMS-approved transplant program list, per the TRICARE Policy Manual (TPM), Ch. 11 Sec. 7.1. This list is maintained at Survey & Certificationâs Quality, Certification, and Oversight Reports (QCOR). To access this list, navigate to Provider Reports and select Approved Transplant Program List.</b></p> 960<p> </p> 961<p>Failure to return this information will result in TRICAREâs use of a provider facilityâs overall operation cost-to-charge ratio to reduce charges, per <a href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2022-12-05/AsOf/TRT5/C1S40.html" target="_blank" data-ispdf="true" data-iscta="false" rel="noopener noreferrer">TRICARE Reimbursement Manual (TRM), Ch.1, Sec. 40</a>. If a facility does not have any SAC rates for the year, providers should provide an explanation.</p> 962<p> </p> 963<p>Please return the required information, including any relevant point of contact to <b><a data-ispdf="false" data-iscta="false" href="mailto:HMHSPricingMailbox@HumanaMilitary.com">HMHSPricingMailbox@HumanaMilitary.com</a></b>. </p> 964 965 </div> 966 <div class="mi-article-cards__content-cta-wrap"> 967 <div slot="cta"> 968 969 970 971 </div> 972 </div> 973</div></div> 974<div class="richText text"> 975<div data-cmp-data-layer="{"20260428-PolicyUpdates":{"xdm:text":"&nbsp; &nbsp; &nbsp;","@type":"humana-military-com/components/richText","@id":"20260428-PolicyUpdates","repo:modifyDate":"2026-04-28T14:57:22Z"}}" id="20260428-PolicyUpdates" class="cmp-text"> 976 <p>   </p> 977 978</div> 979 980 981 982</div> 983<div class="card"> 984 985 986<div class="mi-article-cards__wrapper "> 987 <div class="mi-article-cards__img-wrap"> 988 <img/> 989 </div> 990 <div class="mi-article-cards__content-txt"> 991 <h3 class="mi-article-cards__content-txt-title"> 992 Policy updates: Clarifications on treatment coverage for glioblastoma multiforme, thromboprophylaxis and lymphedema 993 </h3> 994 <div class="mi-article-cards__content-txt-eyebro-txt"> April 28, 2026</div> 995 <p>As of March 13, 2026, TRICARE has clarified its coverage guidelines for durable medical equipment (DME) and specialized therapies for the treatment of glioblastoma multiforme, thromboprophylaxis and lymphedema.</p> 996<p> </p> 997<p><b>Glioblastoma multiforme: Optune® Tumor Treating Fields device</b></p> 998<p>The Optune® Tumor Treating Fields device, formerly known as NovoTTF-100A system, may be covered when used in accordance with Federal Drug Administration (FDA)-labeled indications for adult patients aged 22 or older in the following scenarios:</p> 999<ul><li>Effective September 1, 2012 for patients diagnosed with recurrent glioblastoma multiforme, and</li><li>Effective November 2, 2020 for patients newly diagnosed with supratentorial glioblastoma multiforme.</li></ul> 1000<p> </p> 1001<p>The associated Healthcare Common Procedure Coding System (HCPCS) codes are A4555 and E0766.</p> 1002<p> </p> 1003<p>Learn more at <a href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2026-04-21/AsOf/TPT5/C1S3_1.html" target="_blank" data-ispdf="false" data-iscta="false" rel="noopener noreferrer">TRICARE Policy Manual (TPM), Ch. 1, Sec. 3.1, Para. 2.14</a>.</p> 1004<p> </p> 1005<p><b>Thromboprophylaxis: Intermittent pneumatic compression and sequential pneumatic compression</b></p> 1006<p>Intermittent pneumatic compression and sequential pneumatic compression are covered when used for the treatment of the following:Â
1006</p> 1007<ul><li>Thromboprophylaxis (i.e., prevention of venous thromboembolism, pulmonary embolism and deep vein thrombosis) when medically necessary and appropriate for the patientâs specific medical needs</li><li>Chronic venous insufficiency and post-thrombotic syndrome after six months of documented failure of standard conservative therapy when documented by the contractor as part of their prior authorization review prior to coverage</li></ul> 1008<p> </p> 1009<p>This change also excludes coverage for non-pneumatic compression devices, like Koya Dayspring.</p> 1010<p> </p> 1011<p>Read the full entries, including when prior authorization is required, at <a href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2026-04-20/AsOf/TP15/C4S9_1.html" target="_blank" data-ispdf="false" data-iscta="false" rel="noopener noreferrer">TPM, Ch. 4, Sec. 9.1, Para. 3.22</a>.</p> 1012<p> </p> 1013<p><b>Lymphedema</b>: <b>Pneumatic compression devices</b></p> 1014<p>When purchased or rented as DME, prior authorization is required for coverage of pneumatic compression devices, including intermittent pneumatic compression pumps and sequential pneumatic compression devices, to establish that the requested pump is medically necessary and appropriate for the patientâs specific medical needs, as determined by the ordering physician.</p> 1015<p> </p> 1016<p>This change also excludes coverage for non-pneumatic compression devices.</p> 1017<p> </p> 1018<p>For complete details and the list of exclusions, see <a href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2026-04-21/AsOf/TPT5/C8S17_1.html" target="_blank" data-ispdf="false" data-iscta="false" rel="noopener noreferrer">TRICARE Policy Manual (TPM), Ch. 8, Sec. 17.1, Para. 4.1</a>.</p> 1019 1020 </div> 1021 <div class="mi-article-cards__content-cta-wrap"> 1022 <div slot="cta"> 1023 1024 1025 1026 </div> 1027 </div> 1028</div></div> 1029<div class="richText text"> 1030<div data-cmp-data-layer="{"424-BPCodeChange":{"xdm:text":"&nbsp; &nbsp; &nbsp;","@type":"humana-military-com/components/richText","@id":"424-BPCodeChange","repo:modifyDate":"2026-04-24T18:50:36Z"}}" id="424-BPCodeChange" class="cmp-text"> 1031 <p>   </p> 1032 1033</div> 1034 1035 1036 1037</div> 1038<div class="card"> 1039 1040 1041<div class="mi-article-cards__wrapper "> 1042 <div class="mi-article-cards__img-wrap"> 1043 <img/> 1044 </div> 1045 <div class="mi-article-cards__content-txt"> 1046 <h3 class="mi-article-cards__content-txt-title"> 1047 HCPCS code change: Replacement valves for breast pumps 1048 </h3> 1049 <div class="mi-article-cards__content-txt-eyebro-txt"> April 24, 2026</div> 1050 <p>TRICARE clarified a change order from last fall related to valve replacements for breast pumps. Starting October 1, 2025, the Centers for Medicare and Medicaid Services (CMS) established HCPCS A4288, which replaces HCPCS codes A9999 XG and A9900 XG.</p> 1051<p> </p> 1052<ul><li>Claims submitted after this date using HCPCS  A9999 XG and A9900 XG will be denied. Providers will need to submit a corrected claim.</li><li>Under the new HCPCS code A4288, one unit equals one valve.</li><li>For claims submitted prior to October 1, 2025, using HCPCS A9999 XG or A9900 XG, if valves were billed as sets instead of individual units, providers will also need to submit corrected claims.</li></ul> 1053<p> </p> 1054<p>For more information, see <a href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2026-03-17/AsOf/TPT5/C8S2_6.html">TRICARE Policy Manual (TPM), Ch. 8, Sec. 17.1, Para. 4.1.</a></p> 1055 1056 </div> 1057 <div class="mi-article-cards__content-cta-wrap"> 1058 <div slot="cta"> 1059 1060 1061 1062 </div> 1063 </div> 1064</div></div> 1065<div class="richText text"> 1066<div data-cmp-data-layer="{"414-RiskReduSurgery":{"xdm:text":"&nbsp; &nbsp; &nbsp;","@type":"humana-military-com/components/richText","@id":"414-RiskReduSurgery","repo:modifyDate":"2026-04-24T18:48:56Z"}}" id="414-RiskReduSurgery" class="cmp-text"> 1067 <p>   </p> 1068 1069</div> 1070 1071 1072 1073</div> 1074<div class="card"> 1075 1076 1077<div class="mi-article-cards__wrapper "> 1078 <div class="mi-article-cards__img-wrap"> 1079 <img/> 1080 </div> 1081 <div class="mi-article-cards__content-txt"> 1082 <h3 class="mi-article-cards__content-txt-title"> 1083 Coverage updates for risk-reducing surgeries and mental health treatments 1084 </h3> 1085 <div class="mi-article-cards__content-txt-eyebro-txt"> April 14, 2026</div> 1086 <p>TRICARE recently updated its policy to add new procedure codes and clarifying language for certain risk-reducing surgeries, while also introducing additional exclusions for the treatment of some mental disorders.</p> 1087<p><br /> 1088<b>Risk-reducing surgeries</b><br /> 1089TRICARE now includes coverage for certain risk reducing surgeries for individuals at high risk for developing cancer. Covered procedures include prophylactic bilateral mastectomy, prophylactic salpingo-oophorectomy, or salpingectomy as clinically indicated, and prophylactic hysterectomy. These surgeries are considered proven treatments when provided in concurrence with National Comprehensive Cancer Network (NCCN) or American College of Obstetricians and Gynecologists (ACOG) clinical practice guidelines.</p> 1090<p><br /> 1091<br /> 1092<b>Mental health services</b><br /> 1093</p> 1094<p>This policy change adds new exclusions for certain treatments including off-label use of Cranial Electrical Stimulation (CES) for the treatment of post-traumatic stress disorder (PTSD) and mental health disorders related to traumatic brain injury (TBI). This change also adds a new exclusion for repetitive Transcranial Magnetic Stimulation (rTMS) for the treatment of PTSD.</p> 1095<p> </p> 1096<p>For more information about these updates, please refer to the <a href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2026-03-10/ChangeOnly/TPT5/C4S5_3.html" target="_blank" data-ispdf="false" data-iscta="false" rel="noopener noreferrer">TRICARE Policy Manual (TPM) Ch. 4, Sec. 5.3</a> and <a href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2026-03-10/ChangeOnly/TPT5/C7S3_7.html" target="_blank" data-ispdf="false" data-iscta="false" rel="noopener noreferrer">TPM Ch. 7, Sec. 3.7</a>.</p> 1097 1098 </div> 1099 <div class="mi-article-cards__content-cta-wrap"> 1100 <div slot="cta"> 1101 1102 1103 1104 </div> 1105 </div> 1106</div></div> 1107<div class="richText text"> 1108<div data-cmp-data-layer="{"414-CovCerv":{"xdm:text":"&nbsp; &nbsp; &nbsp;","@type":"humana-military-com/components/richText","@id":"414-CovCerv","repo:modifyDate":"2026-04-14T20:46:46Z"}}" id="414-CovCerv" class="cmp-text"> 1109 <p>   </p> 1110 1111</div> 1112 1113 1114 1115</div> 1116<div class="card"> 1117 1118 1119<div class="mi-article-cards__wrapper "> 1120 <div class="mi-article-cards__img-wrap"> 1121 <img/> 1122 </div> 1123 <div class="mi-article-cards__content-txt"> 1124 <h3 class="mi-article-cards__content-txt-title"> 1125 Updates to TRICARE coverage of cervical cancer screening 1126 </h3> 1127 <div class="mi-article-cards__content-txt-eyebro-txt"> April 14, 2026</div> 1128 <p>Effective April 14, 2026, TRICARE has updated its coverage policy for cervical cancer screening to reflect the latest clinical practice guidelines from the American College of Obstetricians and Gynecologists and the American Society for Colposcopy and Cervical Pathology.</p> 1129<p> </p> 1130<p><b>Pap tests</b></p> 1131<p>TRICARE now covers Papanicolaou (Pap) testing to screen for cervical cancer <b>
1131every three years for female beneficiaries ages 21 through 65</b>. Screening is not recommended for women under age 21, regardless of sexual initiation or other risk factors.</p> 1132<p> </p> 1133<p><b>HPV DNA testing</b></p> 1134<p>Primary Human Papillomavirus (HPV) DNA testing is now covered under the following conditions:</p> 1135<ul><li>Once every <b>five years for women ages 30 through 65</b>.</li><li>U.S. Food and Drug Administration (FDA)-cleared HPV self-collection testing methods are included in the coverage.  </li></ul> 1136<p> </p> 1137<p><b>Co-testing</b></p> 1138<p>Co-testing, which combines a Pap test with HPV DNA testing to detect high risk HPV strains and cervical cell changes, is <b>now covered for women ages 30 through 65 every five years</b>.</p> 1139<p> </p> 1140<p>Please note that the <b>family planning benefit</b> does not include cervical cancer screening, such as Pap tests and HPV testing, or routine gynecologic examinations, including related laboratory testing. However, family planning benefits may be allowed during an office visit during which cervical cancer screening is performed.</p> 1141<p> </p> 1142<p>For more information about these updates, please refer to the <a href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2026-03-17/ChangeOnly/TPT5/C7S2_1.html" target="_blank" data-ispdf="false" data-iscta="false" rel="noopener noreferrer">TRICARE Policy Manual (TPM), Ch. 7, Sec. 2.1</a>, <a href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2026-03-17/ChangeOnly/TPT5/C7S2_2.html" target="_blank" data-ispdf="false" data-iscta="false" rel="noopener noreferrer">TPM Ch. 7, Sec. 2.2</a>, <a href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2026-03-17/AsOf/TPT5/C7S2_3.html" target="_blank" data-ispdf="false" data-iscta="false" rel="noopener noreferrer">TPM Ch. 7, Sec. 2.3</a> and <a href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2026-03-17/AsOf/TPT5/C7S2_4.html" target="_blank" data-ispdf="false" data-iscta="false" rel="noopener noreferrer">TPM Ch. 7, Sec. 2.4</a>.  </p> 1143 1144 </div> 1145 <div class="mi-article-cards__content-cta-wrap"> 1146 <div slot="cta"> 1147 1148 1149 1150 </div> 1151 </div> 1152</div></div> 1153<div class="richText text"> 1154<div data-cmp-data-layer="{"410-chcbp":{"xdm:text":"&nbsp; &nbsp; &nbsp;","@type":"humana-military-com/components/richText","@id":"410-chcbp","repo:modifyDate":"2026-04-14T12:57:58Z"}}" id="410-chcbp" class="cmp-text"> 1155 <p>   </p> 1156 1157</div> 1158 1159 1160 1161</div> 1162<div class="card"> 1163 1164 1165<div class="mi-article-cards__wrapper "> 1166 <div class="mi-article-cards__img-wrap"> 1167 <img/> 1168 </div> 1169 <div class="mi-article-cards__content-txt"> 1170 <h3 class="mi-article-cards__content-txt-title"> 1171 CHCBP Updates 1172 </h3> 1173 <div class="mi-article-cards__content-txt-eyebro-txt"> April 10, 2026</div> 1174 <h5>Updated April 14, 2026</h5> 1175<h5> </h5> 1176<p>We are currently updating the CHCBP system to improve claims processing, apply deductibles, and catastrophic caps correctly, and ensure proper distinction between network and non-network claims outside the East region. During this time, some claims may be routed or processed incorrectly.<br /> 1177<br /> 1178We expect to complete our updates by April 30, 2026, and once they are complete, we will review and correct any affected claims.<br /> 1179<br /> 1180We apologize for any inconvenience this may cause and appreciate your patience.</p> 1181 1182 </div> 1183 <div class="mi-article-cards__content-cta-wrap"> 1184 <div slot="cta"> 1185 1186 1187 1188 </div> 1189 </div> 1190</div></div> 1191<div class="richText text"> 1192<div data-cmp-data-layer="{"20260410-Musculoskeletal":{"xdm:text":"&nbsp; &nbsp; &nbsp;","@type":"humana-military-com/components/richText","@id":"20260410-Musculoskeletal","repo:modifyDate":"2026-04-23T17:00:00Z"}}" id="20260410-Musculoskeletal" class="cmp-text"> 1193 <p>   </p> 1194 1195</div> 1196 1197 1198 1199</div> 1200<div class="card"> 1201 1202 1203<div class="mi-article-cards__wrapper "> 1204 <div class="mi-article-cards__img-wrap"> 1205 <img/> 1206 </div> 1207 <div class="mi-article-cards__content-txt"> 1208 <h3 class="mi-article-cards__content-txt-title"> 1209 Recent changes to musculoskeletal system and neurological and neuromuscular services 1210 </h3> 1211 <div class="mi-article-cards__content-txt-eyebro-txt"> April 10, 2026</div> 1212 <p>TRICARE recently updated the <i>TRICARE Policy Manual</i> (<i>TPM</i>) to specify coverage for procedures related to the musculoskeletal system and neurological and neuromuscular services. The effective dates for coverage for many procedures are retroactive. Please review each procedure below for its implementation date. Since these changes are retroactive, if any physician filed claims that were previously denied for c
1212ompleted procedures, they may submit claims for retrospective/prepay review.</p> 1213<h5> </h5> 1214<h4><b>Coverage additions</b></h4> 1215<p><b>Basivertebral Nerve Ablation (BVNA)</b></p> 1216<p>Intraosseous ablation of the basivertebral nerve (BVN) is now covered using the Intracept®<sup> </sup>system or other Federal Drug Administration (FDA)-approved devices for the treatment of chronic vertebrogenic low-back pain when a patient meets specified criteria. This change is effective July 14, 2022. (<a href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2026-03-17/AsOf/TPT5/C4S20_1.html"><i>TPM</i> Ch. 4, Sec. 20.1</a>)</p> 1217<p> </p> 1218<p><b>Cochlear implantation coverage</b></p> 1219<p>Unilateral cochlear implantation, without a prior hearing-aid trial, is now covered for children with post-meningitis hearing loss. There must be evidence of cochlear ossification or bilateral severe-to-profound sensorineural hearing loss. This policy change is effective April 5, 2021. (<a href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2026-03-17/AsOf/TPT5/C4S22_2.html"><i>TPM</i> Ch. 4, Sec. 22.2</a>)</p> 1220<p> </p> 1221<p><b>Liver transplants</b></p> 1222<p>Liver transplantation is now covered for patients with colorectal cancer with liver metastasis.  Those patients must meet specified inclusion and exclusion criteria as well as obtain prior authorization and approval from a tumor board. This policy change is effective September 21, 2024. (<a href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2026-03-17/AsOf/TPT5/C4S24_5.html"><i>TPM</i> Ch. 4, Sec. 24.5</a>)<b></b></p> 1223<p> </p> 1224<p><b>Mesial Temporal Lobe Epilepsy (MTLE)</b></p> 1225<p>Stereotactic laser amygdalohippocampectomy (SLAH), including MRI-guided Laser Interstitial Thermal Therapy (LITT), may be covered for the treatment of Mesial Temporal Lobe Epilepsy (MTLE) when the procedure is performed in accordance with the recommendations of the American Society for and Functional Neurosurgery (ASSFN). This policy change is effective February 1, 2022. (<a href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2026-03-17/AsOf/TPT5/C7S15_1.html"><i>TPM</i> Ch. 7, Sec. 15.1</a>)</p> 1226<p> </p> 1227<h4><b>Coverage exclusion</b></h4> 1228<p>The intradiscal fibrin sealant (DISCSEEL) procedure is considered unproven for the treatment of discogenic back pain and is not covered. This policy change is effective February 19, 2026. (<a href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2026-03-17/AsOf/TPT5/C4S6_1.html"><i>TPM</i> Ch. 4, Sec. 6.1</a>)</p> 1229<p> </p> 1230<p>See <a href="https://manuals.health.mil/pages/DisplayManual.aspx?SeriesId=TPT5&TPT5=48#TPT5"><i>TPM Change 48, Mar. 17, 2026</i></a> for the most recent edition. </p> 1231 1232 </div> 1233 <div class="mi-article-cards__content-cta-wrap"> 1234 <div slot="cta"> 1235 1236 1237 1238 </div> 1239 </div> 1240</div></div> 1241<div class="richText text"> 1242<div data-cmp-data-layer="{"mhpatientoutcomes":{"xdm:text":"&nbsp; &nbsp; &nbsp;","@type":"humana-military-com/components/richText","@id":"mhpatientoutcomes","repo:modifyDate":"2026-04-23T16:59:14Z"}}" id="mhpatientoutcomes" class="cmp-text"> 1243 <p>   </p> 1244 1245</div> 1246 1247 1248 1249</div> 1250<div class="card"> 1251 1252 1253<div class="mi-article-cards__wrapper "> 1254 <div class="mi-article-cards__img-wrap"> 1255 <img/> 1256 </div> 1257 <div class="mi-article-cards__content-txt"> 1258 <h3 class="mi-article-cards__content-txt-title"> 1259 Mental health patient outcomes: Maintaining compliance 1260 </h3> 1261 <div class="mi-article-cards__content-txt-eyebro-txt"> April 9, 2026</div> 1262 <p>Humana Military wants to remind all mental health providers about the importance of maintaining compliance when documenting patient outcomes. This is a requirement as a TRICARE provider. You must show completion of required specific mental health outcome measure assessment(s).</p> 1263<p>Per the <a href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2026-03-17/AsOf/TPT5/C1S5_1.html"><i>TRICARE Policy Manual</i> (<i>TPM</i>), Ch. 1, Sec. 5.1</a> policy detail sections 3.8 and 4.3.3: <br /> 1264 </p> 1265<p style=" margin-left: 40.0px; 1266">3.8 Across all behavioral health settings (outpatient mental health and SUD, OTPs, IOPs, partial hospital
1266ization, psychiatric RTCs, and inpatient/residential SUDRFs), the following standardized measures will be required at treatment baseline, at 60-day intervals, and at discharge for the corresponding diagnoses (see the <a href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2026-03-27/AsOf/TOT5/C7S6.html"><i>TRICARE Operations Manual</i> (<i>TOM</i>), Ch. 7, Sec. 6</a>):  <br /> 1267<br /> 1268â¢Â  Post-traumatic stress disorder (PTSD):  PTSD Checklist (PCL-5)<br /> 1269â¢Â  Anxiety disorders:  Seven-item Generalized Anxiety Disorder (GAD-7) screening tool<br /> 1270â¢Â  Depressive disorders: Patient Health Questionnaire (PHQ-9 or A)Post-traumatic stress disorder (PTSD):  PTSD Checklist (PCL-5)<br /> 1271 </p> 1272<p style=" margin-left: 40.0px; 1273">4.3.3 A notation of the patientâs current clinical status evidenced by the patientâs signs, symptoms, and documentation of standardized assessment measures (at baseline, at 60-day intervals and at discharge) for PTSD, anxiety disorders and depressive disorders. (Change 42, Sep 12, 2025)<br /> 1274 </p> 1275<p>Please ensure that the outcome measure assessments are completed and the results are documented in the medical record for TRICARE beneficiaries.  </p> 1276 1277 </div> 1278 <div class="mi-article-cards__content-cta-wrap"> 1279 <div slot="cta"> 1280 1281 1282 1283 </div> 1284 </div> 1285</div></div> 1286<div class="richText text"> 1287<div data-cmp-data-layer="{"mhpatientoutcomes":{"xdm:text":"&nbsp; &nbsp; &nbsp;","@type":"humana-military-com/components/richText","@id":"mhpatientoutcomes","repo:modifyDate":"2026-04-09T14:09:13Z"}}" id="mhpatientoutcomes" class="cmp-text"> 1288 <p>   </p> 1289 1290</div> 1291 1292 1293 1294</div> 1295<div class="card"> 1296 1297 1298<div class="mi-article-cards__wrapper "> 1299 <div class="mi-article-cards__img-wrap"> 1300 <img/> 1301 </div> 1302 <div class="mi-article-cards__content-txt"> 1303 <h3 class="mi-article-cards__content-txt-title"> 1304 Q2 2026 reimbursement updates 1305 </h3> 1306 <div class="mi-article-cards__content-txt-eyebro-txt"> April 9, 2026</div> 1307 <p>Humana Military is actively processing claims while we are implementing the following quarterly reimbursement updates. During this process, claims status will be temporarily set to pending, and claims payments will resume once the implementation is complete.</p> 1308<p> </p> 1309<ul><li>Outpatient Prospective Payment System (OPPS)</li><li>
1309Ambulatory Surgery Center (ASC)</li><li>Durable Medical Equipment, Prosthetics, Orthotics, and Supplies/Parenteral, Enteral Nutrition (DMEPOS/PEN)</li><li>Applied Behavior Analysis (ABA) amounts (Effective May 1, 2026)</li></ul> 1310 1311 </div> 1312 <div class="mi-article-cards__content-cta-wrap"> 1313 <div slot="cta"> 1314 1315 1316 1317 </div> 1318 </div> 1319</div></div> 1320<div class="richText text"> 1321<div data-cmp-data-layer="{"abaarticle":{"xdm:text":"&nbsp;&nbsp;","@type":"humana-military-com/components/richText","@id":"abaarticle","repo:modifyDate":"2026-04-02T18:44:36Z"}}" id="abaarticle" class="cmp-text"> 1322 <p>  </p> 1323 1324</div> 1325 1326 1327 1328</div> 1329<div class="card"> 1330 1331 1332<div class="mi-article-cards__wrapper "> 1333 <div class="mi-article-cards__img-wrap"> 1334 <img/> 1335 </div> 1336 <div class="mi-article-cards__content-txt"> 1337 <h3 class="mi-article-cards__content-txt-title"> 1338 Applied Behavior Analysis (ABA) providers: Donât miss your required annual training! 1339 </h3> 1340 <div class="mi-article-cards__content-txt-eyebro-txt"> April 2, 2026</div> 1341 <p>As part of the Autism Care Demonstration (ACD), TRICARE-certified ACD-Corporate Service Providers (ACSP) and Sole Provider (SP) practices are required to attend a provider education training hosted by Humana Military at least once annually. The training includes ACD requirements, correct billing practices, claims filing, authorizations, exclusions, medical record documentation, provider responsibilities and more. Failure to attend the training will result in a 10% claims penalty.</p> 1342<p> </p> 1343<p>A representative responsible for the ACSP is required to attend and is expected to share information with their associates. All associates from the ACSP are not required to attend.</p> 1344<p> </p> 1345<p>Register for an upcoming training: <a href="https://www.humanamilitary.com/provider/resources/webinars">Provider Webinars | Humana Military</a></p> 1346<p> </p> 1347<p>See <a data-ispdf="false" data-iscta="false" href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2025-01-17/AsOf/TOT5/c18s3.html?highlight=ACD%7C%7Cxfilter%28name%20%22c18s3.xml%22%29%20and%20xfilter%28word%20%22CHANGE_TYPE%3A%3AASOF%22%29%20and%20%28xfilter%28word%20%22ACRONYM%3A%3ATOT5%22%20andword%20%22CHANGE_NO%3A%3A36%22%29%29%7C.html#BABFJAFGA9">TRICARE Operations Manual (TOM) Ch. 18, Sec. 3, Para. 8.3 and 9.3</a> for more information on TRICARE provider education requirements.</p> 1348<p> </p> 1349<p>If you have any questions, contact <a href="mailto:HMProviderWebinars@HumanaMilitary.com">HMProviderWebinars@HumanaMilitary.com</a>.</p> 1350 1351 </div> 1352 <div class="mi-article-cards__content-cta-wrap"> 1353 <div slot="cta"> 1354 1355 1356 1357 </div> 1358 </div> 1359</div></div> 1360<div class="richText text"> 1361<div data-cmp-data-layer="{"mhpatientoutcomes":{"xdm:text":"&nbsp; &nbsp; &nbsp;","@type":"humana-military-com/components/richText","@id":"mhpatientoutcomes","repo:modifyDate":"2026-04-09T14:09:13Z"}}" id="mhpatientoutcomes" class="cmp-text"> 1362 <p>   </p> 1363 1364</div> 1365 1366 1367 1368</div> 1369<div class="card"> 1370 1371 1372<div class="mi-article-cards__wrapper "> 1373 <div class="mi-article-cards__img-wrap"> 1374 <img/> 1375 </div> 1376 <div class="mi-article-cards__content-txt"> 1377 <h3 class="mi-article-cards__content-txt-title"> 1378 Free online training course May 12-13: Earn TRICARE Provider Readiness Designation (TPRD) 1379 </h3> 1380 <div class="mi-article-cards__content-txt-eyebro-txt"> March 25, 2026</div> 1381 <p>The Defense Health Agency (DHA) is offering a free, two-day online course for TRICARE providers to earn a TRICARE Provider Readiness Designation (TPRD). The class is May 12-13, 2026, and meets from 9 AM to 5:30 PM ET each day. Individuals must register by May 6.<br /> 1382 </p> 1383<p>Providers who earn the TPRD label are specifically identified in the TRICARE Directory as having specialized knowledge of military culture, ethics and evidence-based treatments. 14 Continuing Education (CE) credits are available for psychologists and s
1383ocial workers.<br /> 1384 </p> 1385<p>Individual classes include:<br /> 1386 </p> 1387<ul><li>Assessing military clients for trauma and Post-Traumatic Stress Disorder (PTSD)</li><li>Ethical considerations for working with military members and veterans</li><li>Military culture: Enhancing clinical competence</li><li>Addressing suicide with military-connected patients</li><li>Overview of sleep disorders common in military members</li><li>Use of screening tools</li></ul> 1388<p><b> </b></p> 1389<p><a href="https://deploymentpsych.org/TPRD-12-13-May-26">Register online by May 6, 2026.</a></p> 1390 1391 </div> 1392 <div class="mi-article-cards__content-cta-wrap"> 1393 <div slot="cta"> 1394 1395 1396 1397 </div> 1398 </div> 1399</div></div> 1400<div class="richText text"> 1401<div data-cmp-data-layer="{"20250925-MultipleCopays":{"xdm:text":"&nbsp;&nbsp;","@type":"humana-military-com/components/richText","@id":"20250925-MultipleCopays","repo:modifyDate":"2025-09-25T12:08:54Z"}}" id="20250925-MultipleCopays" class="cmp-text"> 1402 <p>  </p> 1403 1404</div> 1405 1406 1407 1408</div> 1409<div class="card"> 1410 1411 1412<div class="mi-article-cards__wrapper "> 1413 <div class="mi-article-cards__img-wrap"> 1414 <img/> 1415 </div> 1416 <div class="mi-article-cards__content-txt"> 1417 <h3 class="mi-article-cards__content-txt-title"> 1418 Updates to Laboratory Developed Tests (LDT) tumor profiling coverage and new location for demonstration list 1419 </h3> 1420 <div class="mi-article-cards__content-txt-eyebro-txt"> March 13, 2026</div> 1421 <p>Effective March 13, 2026, TRICARE has clarified the coverage policy to allow the use of certain genetic tests for medical management purposes, including non-companion diagnostic tumor profiling when recommended by professional organization guidelines.</p> 1422<p><br /> 1423This addition clarifies that the TRICARE benefit includes on-label use of tests that may not have Food and Drug Administration (FDA)-approval, provided professional organizations recommend their use in clinical guidelines. <a data-iscta="false" data-ispdf="false" href="https://health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement/Laboratory-Developed-Tests">These tests are covered</a> if they meet medical management goals, such as delivering cost-effective care to promote beneficiary health outcome(s).</p> 1424<p><br /> 1425TRICARE also continues to cover genetic tests that have received United States (US) Food and Drug Administration (FDA) medical device 510(k) clearance or premarket approval, as long as they are medically necessary for the diagnosis or treatment of an illness or injury and have demonstrated clinical utility.</p> 1426<p><br /> 1427Additionally, <a href="https://health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement/Laboratory-Developed-Tests">the list of non-FDA approved genetic tests </a> covered under the DHA Evaluation of Non-FDA Approved Laboratory Developed Tests (LDTs) Demonstration Project is now available at <a href="http://www.health.mil/">health.mil</a>.  </p> 1428<p><br /> 1429For more information, visit <a href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2026-03-10/AsOf/TPT5/C6S3_1.html">TRICARE Policy Manual (TPM) Ch. 6, Sec. 3.1</a>.<i></i></p> 1430 1431 </div> 1432 <div class="mi-article-cards__content-cta-wrap"> 1433 <div slot="cta"> 1434 1435 1436 1437 </div> 1438 </div> 1439</div></div> 1440<div class="richText text"> 1441<div data-cmp-data-layer="{"20250302-claimsdenialsVHS":{"xdm:text":"&nbsp; &nbsp; &nbsp;","@type":"humana-military-com/components/richText","@id":"20250302-claimsdenialsVHS","repo:modifyDate":"2026-07-01T15:40:24Z"}}" id="20250302-claimsdenialsVHS" class="cmp-text"> 1442 <p>   </p> 1443 1444</div> 1445 1446 1447 1448</div> 1449<div class="card"> 1450 1451 1452<div class="mi-article-cards__wrapper "> 1453 <div class="mi-article-cards__img-wrap"> 1454 <img/> 1455 </div> 1456 <div class="mi-article-cards__content-txt"> 1457 <h3 class="mi-article-cards__content-txt-title"> 1458 Avoid claim denials for virtual-health services 1459 </h3> 1460 <div class="mi-article-cards__content-txt-eyebro-txt"> March 2, 2026</div> 1461 <p>Humana Military is updating its claims review process for virtual-health services to validate that providers are complying with state licensure and certification requirements. <br /> 1462 </p> 1463<p>In accordance with Defense Health Agency (DHA) guidelines, virtual-health providers must have a license or certification in accordance with appropriate state laws and federal regulations. <br /> 1464 </p> 1465<p>Virtual healthcare providers must comply with the following requirements:</p> 1466<ul><li>A practitioner must have licensure in the state where the beneficiary is located at the time of service. </li><li>A practitioner must follow the licensure/certification requirements in the state where they practice.</li></ul> 1467<p><b><br /> 1468Take action<br /> 1469  </b></p> 1470<p>Providers should validate that they have a current license in the state where they practice and in the state where a beneficiary is located at the time of service. </p> 1471<p><br /> 1472For more information, visit <a data-ispdf="false" data-iscta="false" href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2025-01-17/AsOf/tpt5/c7s22_1.html">TRICARE Policy Manual (TPM), Ch. 7. Sec. 2.3.1.2, 2.2.3.4 and 3.2</a>. </p> 1473 1474 </div> 1475 <div class="mi-article-cards__content-cta-wrap"> 1476 <div slot="cta"> 1477 1478 1479 1480 </div> 1481 </div> 1482</div></div> 1483<div class="richText text"> 1484<div data-cmp-data-layer="{"mhpatientoutcomes":{"xdm:text":"&nbsp; &nbsp; &nbsp;","@type":"humana-military-com/components/richText","@id":"mhpatientoutcomes","repo:modifyDate":"2026-04-09T14:09:13Z"}}" id="mhpatientoutcomes" class="cmp-text"> 1485 <p>   </p> 1486 1487</div> 1488 1489 1490 1491</div> 1492<div class="card"> 1493 1494 1495<div class="mi-article-cards__wrapper "> 1496 <div class="mi-article-cards__img-wrap"> 1497 <img/> 1498 </div> 1499 <div class="mi-article-cards__content-txt"> 1500 <h3 class="mi-article-cards__content-txt-title"> 1501 DHA offering free online course March 11-12 to earn TRICARE Provider Readiness Designation (TPRD)âregister by March 3 1502 </h3> 1503 <div class="mi-article-cards__content-txt-eyebro-txt"> February 25, 2026</div> 1504 <p>The Defense Health Agency (DHA) is offering a free, two-day, online course for TRICARE providers to earn a TRICARE Provider Readiness Designation (TPRD). The class is March 11-12, 2026, and meets from 9 AM to 5:30 PM ET each day. Individuals must register by March 3.</p> 1505<p><br /> 1506Providers who earn the TPRD label are specifically identified in the TRICARE Directory<i> </i>as having specialized knowledge of military culture, ethics and evidence-based treatments. Fourteen Continuing Education (CE) credits are available for psychologists and s
1506ocial workers.</p> 1507<p><br /> 1508Content covered includes:<br /> 1509Â </p> 1510<ul><li>Assessing military clients for trauma and PTSD</li><li>Ethical considerations for working with military members and veterans</li><li>Military culture: enhancing clinical competence</li><li>Addressing suicide with military-connected patients</li><li>Overview of sleep disorders common in military members</li><li>Use of screening tools</li></ul> 1511<p><b>Â </b></p> 1512<p><a href="https://deploymentpsych.org/TPRD-11-12-Mar-26">Register online by March 3, 2026</a></p> 1513 1514 </div> 1515 <div class="mi-article-cards__content-cta-wrap"> 1516 <div slot="cta"> 1517 1518 1519 1520 </div> 1521 </div> 1522</div></div> 1523<div class="richText text"> 1524<div data-cmp-data-layer="{"mhpatientoutcomes":{"xdm:text":"&nbsp; &nbsp; &nbsp;","@type":"humana-military-com/components/richText","@id":"mhpatientoutcomes","repo:modifyDate":"2026-04-09T14:09:13Z"}}" id="mhpatientoutcomes" class="cmp-text"> 1525 <p>Â Â Â </p> 1526 1527</div> 1528 1529 1530 1531</div> 1532<div class="card"> 1533 1534 1535<div class="mi-article-cards__wrapper "> 1536 <div class="mi-article-cards__img-wrap"> 1537 <img/> 1538 </div> 1539 <div class="mi-article-cards__content-txt"> 1540 <h3 class="mi-article-cards__content-txt-title"> 1541 2026 Q1 TRICARE reimbursement implementation update 1542 </h3> 1543 <div class="mi-article-cards__content-txt-eyebro-txt"> January 7, 2026</div> 1544 <p>Humana Military is actively processing claims while we are implementing the following quarterly reimbursement updates. During this process, claims status will be temporarily set to pending, and claims payments will resume once the implementation is complete.<br /> 1545Â </p> 1546<ul><li>Outpatient Prospective Payment System (OPPS)</li><li>CMS Durable Medical Equipment Prosthetics, Orthotics and Supplies (DMEPOS)</li><li>CMS Durable Medical Equipment Parenteral and Enteral Nutrition (DMEPEN)</li><li>TRICARE DMEPOS</li><li>TRICARE Maximum Allowable Charge (CMAC) rates</li><li>Annual Diagnostic Related Grouping (DRG) file</li><li>Sole Community Hospital (SCH) cost-to-charge ratios</li><li>
1546Ambulatory Surgery Center (ASC) rates</li><li>Banked Donor Milk (BDM) rates</li><li>Injectable rates</li><li>Breastfeeding Supplies (BFS) rates</li><li>Skilled Nursing Facility (SNF) payment system</li><li>Inpatient Rehab Facility (IRF) payment system</li><li>Long Term Care Hospital (LTCH) payment system</li><li>CY 2026 Cost Shares</li></ul> 1547<p> </p> 1548<p>Due to a delay in the Calendar Year (CY) 2026/Q1 Outpatient Prospective Payment System (OPPS) Pricer receipt, there will be a delay in claims processing.</p> 1549<p><br /> 1550This processing delay applies to claims with dates of service on or after January 1, 2026. Once the updated pricer is implemented, affected claims will be processed and paid according to normal procedures.</p> 1551<p><br /> 1552We appreciate your patience and understanding.</p> 1553 1554 </div> 1555 <div class="mi-article-cards__content-cta-wrap"> 1556 <div slot="cta"> 1557 1558 1559 1560 </div> 1561 </div> 1562</div></div> 1563<div class="richText text"> 1564<div data-cmp-data-layer="{"mhpatientoutcomes":{"xdm:text":"&nbsp; &nbsp; &nbsp;","@type":"humana-military-com/components/richText","@id":"mhpatientoutcomes","repo:modifyDate":"2026-04-09T14:09:13Z"}}" id="mhpatientoutcomes" class="cmp-text"> 1565 <p>   </p> 1566 1567</div> 1568 1569 1570 1571</div> 1572<div class="card"> 1573 1574 1575<div class="mi-article-cards__wrapper "> 1576 <div class="mi-article-cards__img-wrap"> 1577 <img/> 1578 </div> 1579 <div class="mi-article-cards__content-txt"> 1580 <h3 class="mi-article-cards__content-txt-title"> 1581 Virtual health billing guidelines for Place of Service (POS) 1582 </h3> 1583 <div class="mi-article-cards__content-txt-eyebro-txt"> October 6, 2025</div> 1584 <p>POS refers to where a beneficiary is located for a  virtual health encounter when they receive care. This is known as the origination site. The providerâs location at the time of service is known as the distant site.</p> 1585<p> </p> 1586<p><b>What determines the POS code?</b></p> 1587<p>The POS code is dictated by the beneficiaryâs location, or origination site, when the service is rendered.</p> 1588<p> </p> 1589<p>For example:</p> 1590<ul><li>If a beneficiary is physically located at home during the  virtual health encounter, then a POS code indicating the beneficiary is home, or a more appropriate POS indicating private residence, would be denoted.</li><li>If a beneficiary is physically located in a hospital, facility or clinic setting (not a private residence) at the time of the virtual health encounter, then a POS code indicating the facility type would be denoted.</li></ul> 1591<p> </p> 1592<p>For an up-to-date list of POS codes, please refer to <a href="https://www.cms.gov/medicare/coding-billing/place-of-service-codes/code-sets" title="https://www.cms.gov/medicare/coding-billing/place-of-service-codes/code-sets" target="_blank" data-ispdf="false" data-iscta="false" rel="noopener noreferrer">this code set</a>.</p> 1593<p> </p> 1594<p><b>Synchronous virtual health services</b></p> 1595<p>These services involve an interactive, electronic information exchange in at least two directions in the same time period. Providers billing for synchronous virtual health services will use either a CPT or an HCPCS code paired with a GT modifier (a specific modifier which signifies that services were provided virtually using real-time interactive audio and video technology) for distant site. This will be used along with the codeQ3014 for an applicable originating site to distinguish virtual health services.</p> 1596<p> </p> 1597<p><b>Asynchronous virtual health services</b></p> 1598<p>These services involve storing, forwarding and transmitting medical information on virtual health encounters, one direction at a time. Providers billing for asynchronous virtual health services will use CPT or HCPCS codes with a GQ modifier (a virtual health service rendered via an asynchronous telecommunications system).</p> 1599<p> </p> 1600<p>When submitting claims for virtual health services, the provider may indicate "Signature not required â distance virtual health site" in the required patient signature field.</p> 1601<p> </p> 1602<p>See more on virtual health services from <a href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2025-01-17/AsOf/TOT5/c27s1.html" title="https://manuals.health.mil/pages/displaymanualhtmlfile/2025-01-17/asof/tot5/c27s1.html" target="_blank" data-ispdf="false" data-iscta="false" rel="noopener noreferrer"><b>TRICARE Policy Manual (TPM), Ch. 27, Sec. 1</b></a> and the <a href="https://www.humanamilitary.com/content/dam/sites/humana-military-com/provider/tricare-provider-handbook.pdf" title="https://www.humanamilitary.com/content/dam/sites/humana-military-com/provider/tricare-provider-handbook.pdf" target="_blank" data-ispdf="true" data-iscta="false" rel="noopener noreferrer"><b>TRICARE provider handbook</b></a>.</p> 1603 1604 </div> 1605 <div class="mi-article-cards__content-cta-wrap"> 1606 <div slot="cta"> 1607 1608 1609 1610 </div> 1611 </div> 1612</div></div> 1613<div class="richText text"> 1614<div data-cmp-data-layer="{"mhpatientoutcomes":{"xdm:text":"&nbsp; &nbsp; &nbsp;","@type":"humana-military-com/components/richText","@id":"mhpatientoutcomes","repo:modifyDate":"2026-04-09T14:09:13Z"}}" id="mhpatientoutcomes" class="cmp-text"> 1615 <p>   </p> 1616 1617</div> 1618 1619 1620 1621</div> 1622<div class="card"> 1623 1624 1625<div class="mi-article-cards__wrapper "> 1626 <div class="mi-article-cards__img-wrap"> 1627 <img/> 1628 </div> 1629 <div class="mi-article-cards__content-txt"> 1630 <h3 class="mi-article-cards__content-txt-title"> 1631 Reminder about multiple copays for Prime and Select visits 1632 </h3> 1633 <div class="mi-article-cards__content-txt-eyebro-txt"> September 25, 2025</div> 1634 <p>Weâd like to remind providers of the requirements under the National Defense Authorization Act (NDAA) 2017, which governs how copayments and cost-shares apply for TRICARE Prime and Select benef
1634iciaries. In some scenarios, multiple copayments may apply for a single visit.</p> 1635<p> </p> 1636<p>These situations include:</p> 1637<ul><li>Ancillary services billed in addition to the main visit</li><li>Visits generating both facility and professional fees</li><li>Multiple visits to different providers on the same day</li></ul> 1638<p> </p> 1639<p>For more details around copayments and cost-shares, please visit the <a href="https://tricare.mil/Costs/Compare" target="_blank" data-ispdf="false" data-iscta="false" rel="noopener noreferrer">Costs and Costs page on tricare.mil</a>. </p> 1640 1641 </div> 1642 <div class="mi-article-cards__content-cta-wrap"> 1643 <div slot="cta"> 1644 1645 1646 1647 </div> 1648 </div> 1649</div></div> 1650<div class="richText text"> 1651<div data-cmp-data-layer="{"2025098-SupervisionRequirements":{"xdm:text":"&nbsp;&nbsp;","@type":"humana-military-com/components/richText","@id":"2025098-SupervisionRequirements","repo:modifyDate":"2025-09-18T18:12:56Z"}}" id="2025098-SupervisionRequirements" class="cmp-text"> 1652 <p>  </p> 1653 1654</div> 1655 1656 1657 1658</div> 1659<div class="card"> 1660 1661 1662<div class="mi-article-cards__wrapper "> 1663 <div class="mi-article-cards__img-wrap"> 1664 <img/> 1665 </div> 1666 <div class="mi-article-cards__content-txt"> 1667 <h3 class="mi-article-cards__content-txt-title"> 1668 Change in supervision requirements for physical and occupational therapist assistants 1669 </h3> 1670 <div class="mi-article-cards__content-txt-eyebro-txt"> September 18, 2025</div> 1671 <p>Recent TRICARE policy changed the supervision requirements for physical therapy assistants (PTA) and occupational therapy assistants (OTA) in private practice effective January 1, 2025. The change indicates that general supervision is acceptable for PTAs supervised by physical therapists as well as for OTAs supervised by occupational therapists instead of direct supervision as previously required. </p> 1672<p> </p> 1673<p>For more information, visit the <a href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2025-09-12/AsOf/TPT5/C11TOC.html" target="_blank" data-ispdf="false" data-iscta="false" rel="noopener noreferrer">TRICARE Policy Manual (TPM), Ch. 11</a>.  </p> 1674 1675 </div> 1676 <div class="mi-article-cards__content-cta-wrap"> 1677 <div slot="cta"> 1678 1679 1680 1681 </div> 1682 </div> 1683</div></div> 1684<div class="richText text"> 1685<div data-cmp-data-layer="{"20250916-RemoveHCDevices":{"xdm:text":"&nbsp;&nbsp;","@type":"humana-military-com/components/richText","@id":"20250916-RemoveHCDevices","repo:modifyDate":"2025-09-16T17:46:21Z"}}" id="20250916-RemoveHCDevices" class="cmp-text"> 1686 <p>  </p> 1687 1688</div> 1689 1690 1691 1692</div> 1693<div class="card"> 1694 1695 1696<div class="mi-article-cards__wrapper "> 1697 <div class="mi-article-cards__img-wrap"> 1698 <img/> 1699 </div> 1700 <div class="mi-article-cards__content-txt"> 1701 <h3 class="mi-article-cards__content-txt-title"> 1702 Recent changes to remove coverage of some treatments and healthcare devices 1703 </h3> 1704 <div class="mi-article-cards__content-txt-eyebro-txt"> September 16, 2025</div> 1705 <p>The following treatments and/or wearable devices will no longer be covered by TRICARE and are excluded from policy as they are considered unproven treatment modalities:</p> 1706<ul><li>Histotripsy treatment using the Edison System or future similar devices, for the treatment of liver tumors (<a href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2025-06-18/AsOf/TPT5/C1S1_2.html">TPM Ch. 1, Sec. 1.2</a>).</li><li>Wearable seizure devices and detection devices (<a href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2025-06-18/AsOf/TPT5/C4S13_1.html">TPM Ch.4, Sec, 13.1</a>).</li><li>Thermal pulsation devices, not limited to the LipiFlow device for the treatment of Meibomian Gland Dysfunction (MGD) and associated dry eye disease (<a href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2025-06-18/AsOf/TPT5/C4S21_1.html">TPM Ch. 4, Sec. 21.1</a>).</li><li>Low-Level Laser Therapy (LLLT) (also known as low level light therapy, laser acupuncture, cold laser therapy and photobiomodulation) for treatment of arthritis (<a href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2025-06-18/AsOf/TPT5/C7S18_1.html">TPM Ch. 7, Sec. 18.1</a>).</li><li>Ultrasonic diathermy, also known as sustained acoustic medicine for arthritis, chronic pain and soft tissue injuries. This includes at-home, wearable (SAMdevices) manufactured by ZetrOZ (<a href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2025-06-18/AsOf/TPT5/C7S18_2.html">TPM Ch. 7, Sec. 18.2</a>). </li></ul> 1707 1708 </div> 1709 <div class="mi-article-cards__content-cta-wrap"> 1710 <div slot="cta"> 1711 1712 1713 1714 </div> 1715 </div> 1716</div></div> 1717<div class="richText text"> 1718<div data-cmp-data-layer="{"20250915-MedRecScript":{"xdm:text":"&nbsp;&nbsp;","@type":"humana-military-com/components/richText","@id":"20250915-MedRecScript","repo:modifyDate":"2025-09-16T17:47:16Z"}}" id="20250915-MedRecScript" class="cmp-text"> 1719 <p>  </p> 1720 1721</div> 1722 1723 1724 1725</div> 1726<div class="card"> 1727 1728 1729<div class="mi-article-cards__wrapper "> 1730 <div class="mi-article-cards__img-wrap"> 1731 <img/> 1732 </div> 1733 <div class="mi-article-cards__content-txt"> 1734 <h3 class="mi-article-cards__content-txt-title"> 1735 Update on claims with no associated medical records 1736 </h3> 1737 <div class="mi-article-cards__content-txt-eyebro-txt"> September 15, 2025</div> 1738 <p>We are experiencing a temporary delay in reviewing and processing claims requiring additional information. This is due to the removal of claims from the system that didnât have any medical records associated with them.</p> 1739<p> </p> 1740<p>Providers do not need to resubmit claims. To help ensure all claims are processed and reviewed accurately, please allow up to 90 days from the date you submit the claim before resubmitting duplicate documentation. This gives us time to take care of the backlog and make any needed corrections to claims.</p> 1741<p> </p> 1742<p>Once the backlog is cleared, the claims will be processed within the normal processing time. </p> 1743<p> </p> 1744<p>We understand this delay may cause some inconvenience, and we truly appreciate your patience and understanding as we work to complete all requests.</p> 1745 1746 </div> 1747 <div class="mi-article-cards__content-cta-wrap"> 1748 <div slot="cta"> 1749 1750 1751 1752 </div> 1753 </div> 1754</div></div> 1755<div class="richText text"> 1756<div data-cmp-data-layer="{"20250915-GDLimit":{"xdm:text":"&nbsp;&nbsp;","@type":"humana-military-com/components/richText","@id":"20250915-GDLimit","repo:modifyDate":"2025-09-16T17:41:29Z"}}" id="20250915-GDLimit" class="cmp-text"> 1757 <p>  </p> 1758 1759</div> 1760 1761 1762 1763</div> 1764<div class="card"> 1765 1766 1767<div class="mi-article-cards__wrapper "> 1768 <div class="mi-article-cards__img-wrap"> 1769 <img/> 1770 </div> 1771 <div class="mi-article-cards__content-txt"> 1772 <h3 class="mi-article-cards__content-txt-title"> 1773 Limitations of treatment of Gender Dysphoria (GD) in minors 1774 </h3> 1775 <div class="mi-article-cards__content-txt-eyebro-txt"> September 15, 2025</div> 1776 <p>As of August 18, 2025, TRICARE has updated the coverage policy for Gender Dysphoria (GD) treatment for minors up to the age of 18. Please see a summary of the changes below:</p> 1777<p> </p> 1778<h4><b>Mental health care</b></h4> 1779<p>Mental healthcare services for the diagnosis and treatment of GD are covered for all benef
1779iciaries without a referral, which is consistent with all other diagnoses. Treatment team conferences are also covered.</p> 1780<p> </p> 1781<p><i>Whatâs changed?</i></p> 1782<p>Psychotherapy services for treatment of GD and for beneficiaries pursuing transition are excluded.</p> 1783<p> </p> 1784<h4><b>Endocrine treatment</b></h4> 1785<p>Cross-sex hormone treatment is covered for adults only, ages 19 and older.</p> 1786<p> </p> 1787<p><i>Whatâs changed?</i></p> 1788<p>Cross-sex hormone treatment is excluded for adolescents up to the age of 18.</p> 1789<p> </p> 1790<p><i>What hasnât changed?</i></p> 1791<p>Beneficiaries still need to meet the eligibility standards set by the Endocrine Societyâs clinical practice guidelines. Also, the beneficiary canât have contradictions to hormone therapy.</p> 1792<p> </p> 1793<h4><b>Exclusions</b></h4> 1794<p>Clarification of surgery exclusions and exclusions of other treatments.</p> 1795<p> </p> 1796<p><i>Whatâs changed?</i></p> 1797<ol><li>Surgical procedures and all services and supplies for the treatment of GD are excluded. The surgical procedures are defined as ones that attempt to transform an individualâs physical appearance to align with an identity that differs from his or her sex or that attempt to alter or remove an individualâs sexual organs to order or destroy their natural biological functions.</li><li>Regardless of age, puberty blockers are excluded.</li><li>The use of sex hormones is excluded.</li></ol> 1798<p> </p> 1799<p><i>What hasnât changed?</i></p> 1800<p>All services to preserve fertility and voice therapy by a speech pathologist were previously excluded and continue to be.</p> 1801<p> </p> 1802<p>For more information, visit the <a href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2025-09-12/AsOf/TPT5/C7S1_2.html" target="_blank" data-ispdf="false" data-iscta="false" rel="noopener noreferrer">TRICARE Policy Manual (TPM), Ch. 7, Sec. 1.2</a>.</p> 1803 1804 </div> 1805 <div class="mi-article-cards__content-cta-wrap"> 1806 <div slot="cta"> 1807 1808 1809 1810 </div> 1811 </div> 1812</div></div> 1813<div class="richText text"> 1814<div data-cmp-data-layer="{"20250909-MaternityPreadmission":{"xdm:text":"&nbsp;&nbsp;","@type":"humana-military-com/components/richText","@id":"20250909-MaternityPreadmission","repo:modifyDate":"2025-09-09T17:27:06Z"}}" id="20250909-MaternityPreadmission" class="cmp-text"> 1815 <p>  </p> 1816 1817</div> 1818 1819 1820 1821</div> 1822<div class="card"> 1823 1824 1825<div class="mi-article-cards__wrapper "> 1826 <div class="mi-article-cards__img-wrap"> 1827 <img/> 1828 </div> 1829 <div class="mi-article-cards__content-txt"> 1830 <h3 class="mi-article-cards__content-txt-title"> 1831 Maternity care preadmission and preauthorization reviews 1832 </h3> 1833 <div class="mi-article-cards__content-txt-eyebro-txt"> September 9, 2025</div> 1834 <p>As a clarification around the current TRICARE contract, Humana Military is required to perform preadmission and preauthorization reviews for all inpatient hospitalizations, unless the admission is emergent.</p> 1835<p> </p> 1836<p>Please note the following requirements:</p> 1837<ul><li>For TRICARE Prime and Select beneficiaries: OB providers must submit preadmission requests to Humana Military for any pre-planned hospital admissions such as scheduled inductions and routine vaginal deliveries based on estimated due dates.</li><li>For all unplanned preterm admissions: To avoid any late penalties, hospitals are required to notify Humana Military within 24 hours, or the next business day, following the admission.</li></ul> 1838<p> </p> 1839<p>See <a href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2025-08-06/AsOf/TOT5/C7S4.html">TRICARE Operations Manual (TOM) Ch. 7, Sec. 4</a>, or the<a> </a><a data-ispdf="false" data-iscta="false" href="https://www.humanamilitary.com/content/dam/sites/humana-military-com/provider/tricare-provider-handbook.pdf">TRICARE Provider Handbook</a> â Maternity Care section for more information.</p> 1840 1841 </div> 1842 <div class="mi-article-cards__content-cta-wrap"> 1843 <div slot="cta"> 1844 1845 1846 1847 </div> 1848 </div> 1849</div></div> 1850<div class="richText text"> 1851<div data-cmp-data-layer="{"20250909-HIVPrEP":{"xdm:text":"&nbsp;&nbsp;","@type":"humana-military-com/components/richText","@id":"20250909-HIVPrEP","repo:modifyDate":"2025-09-09T16:05:58Z"}}" id="20250909-HIVPrEP" class="cmp-text"> 1852 <p>  </p> 1853 1854</div> 1855 1856 1857 1858</div> 1859<div class="card"> 1860 1861 1862<div class="mi-article-cards__wrapper "> 1863 <div class="mi-article-cards__img-wrap"> 1864 <img/> 1865 </div> 1866 <div class="mi-article-cards__content-txt"> 1867 <h3 class="mi-article-cards__content-txt-title"> 1868 TRICARE Coverage of Chemotherapy Drugs 1869 </h3> 1870 <div class="mi-article-cards__content-txt-eyebro-txt"> September 9, 2025</div> 1871 <p>This change removes outdated information and clarifies that chemotherapy drugs, including paclitaxel, are covered consistent with Food and Drug Administration (FDA)-labeled indications, or off-label use, consistent with National Comprehensive Cancer Network recommendations for the treatment of cancer.</p> 1872<p> </p> 1873<p>See more at: <a href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2025-08-12/A
1873sOf/TPT5/C7S16_3.html" target="_blank" data-ispdf="false" data-iscta="false" rel="noopener noreferrer">TRICARE Policy Manual (TPM), Ch. 7. Sec. 16.3</a>.</p> 1874 1875 </div> 1876 <div class="mi-article-cards__content-cta-wrap"> 1877 <div slot="cta"> 1878 1879 1880 1881 </div> 1882 </div> 1883</div></div> 1884<div class="richText text"> 1885<div data-cmp-data-layer="{"20250909-HIVPrEP":{"xdm:text":"&nbsp;&nbsp;","@type":"humana-military-com/components/richText","@id":"20250909-HIVPrEP","repo:modifyDate":"2025-09-09T16:05:58Z"}}" id="20250909-HIVPrEP" class="cmp-text"> 1886 <p>Â Â </p> 1887 1888</div> 1889 1890 1891 1892</div> 1893<div class="card"> 1894 1895 1896<div class="mi-article-cards__wrapper "> 1897 <div class="mi-article-cards__img-wrap"> 1898 <img/> 1899 </div> 1900 <div class="mi-article-cards__content-txt"> 1901 <h3 class="mi-article-cards__content-txt-title"> 1902 TRICARE Prime and TRICARE Select HIV Pre-Exposure Prophylaxis (PrEP) 1903 </h3> 1904 <div class="mi-article-cards__content-txt-eyebro-txt"> September 9, 2025</div> 1905 <p>This change allows cost-sharing of Pre-Exposure Prophylaxis (PrEP) for the prevention of HIV as a covered preventive care service for TRICARE Prime and Select beneficiaries.</p> 1906<p>Â </p> 1907<p>HIV PrEP: Provide FDA-approved AntiRetroviral Therapy (ART) as PrEP for the prevention of HIV acquisition to:</p> 1908<ul><li>Sexually active adults and adolescents who weigh at least 35 kilograms (77 pounds) who do not have HIV and are at an increased risk of HIV; and</li><li>Persons who inject drugs and share injection equipment or have a drug-injecting partner who has HIV.</li></ul> 1909<p>Â </p> 1910<p>Persons who are prescribed PrEP should receive regular HIV screening and risk reduction counseling at the following intervals:</p> 1911<ul><li>At one month and three months after starting medication, then every three months, if prescribed daily, oral medications Tenofovir Disoproxil Fumarate/Emtricitabine (TDF/FTC) or Tenofovir Alafenamide/Emtricitabine (TAF/FTC);</li><li>At one month and two months after starting medication, then every other month, if given the injectable cabotegravir.</li></ul> 1912<p>Â </p> 1913<p>Note: PrEP services shall be provided and cost-shared in accordance with United States Preventive Services Task Force guidelines as they are updated.</p> 1914 1915 </div> 1916 <div class="mi-article-cards__content-cta-wrap"> 1917 <div slot="cta"> 1918 1919 1920 1921 </div> 1922 </div> 1923</div></div> 1924<div class="richText text"> 1925<div data-cmp-data-layer="{"20250909-CPTCodeChanges":{"xdm:text":"&nbsp;&nbsp;","@type":"humana-military-com/components/richText","@id":"20250909-CPTCodeChanges","repo:modifyDate":"2025-09-09T16:03:42Z"}}" id="20250909-CPTCodeChanges" class="cmp-text"> 1926 <p>Â Â </p> 1927 1928</div> 1929 1930 1931 1932</div> 1933<div class="card"> 1934 1935 1936<div class="mi-article-cards__wrapper "> 1937 <div class="mi-article-cards__img-wrap"> 1938 <img/> 1939 </div> 1940 <div class="mi-article-cards__content-txt"> 1941 <h3 class="mi-article-cards__content-txt-title"> 1942 Recent changes to covered and excluded services 1943 </h3> 1944 <div class="mi-article-cards__content-txt-eyebro-txt"> September 9, 2025</div> 1945 <p>TRICARE made changes to CPT codes that are newly covered or now excluded. Please review the following code updates and implement their use in claims.</p> 1946<p>Â </p> 1947<h4><b>New coverage</b></h4> 1948<p>Telephonic office visits: CPT codes 98012-98016<b></b></p> 1949<p>Telephonic office visits have been added to coverage with these specifications: The provider must be TRICARE- authorized and hold the visit via telephone call with a beneficiary who is an established patient. The visit must be for covered, medically necessary and appropriate care which does not require face-to-face, hands-on treatment or visual evaluation (e.g., evaluation of a skin lesion or intensive outpatient programs).<b></b></p> 1950<p>Â </p> 1951<p>Noninvasive heart failure detection: CPT code 0932T</p> 1952<p>Noninvasive heart failure detection is covered to confirm diagnosis of Heart Failure with Preserved Ejection Fraction (HFpEF) when augmentative analysis of an echocardiogram demonstrated preserved ejection fraction.</p> 1953<p>Â </p> 1954<p>
1954Chimeric Antigen Receptor T-cell (CAR-T) cell therapy: CPT codes 38225-38228</p> 1955<p>CAR-T cell therapy for is now covered.</p> 1956<p> </p> 1957<h4><b>Code replacement</b></h4> 1958<p>Unilateral thalamotomy: CPT code 61715 replaced 0398T<b></b></p> 1959<p>Unilateral thalamotomy using Magnetic Resonance Image Guided Focused Ultrasound Surgery (MRgFUS) for treatment of medication-refractory essential tremor, may be covered. It must be provided with Food and Drug Administration-approved (FDA-approved) devices and in accordance with the American Society for Stereotactic and Functional Neurosurgery (ASSFN) coverage criteria.</p> 1960<p> </p> 1961<h4><b>Clarification</b></h4> 1962<p>Breast MRIs: CPT codes 77046-77047</p> 1963<p> </p> 1964<p>Breast MRIs are covered for the following indications, which are not inclusive:</p> 1965<ul><li>To detect breast implant rupture if the implantation procedure was, or would have been, covered by TRICARE (e.g., related to a covered mastectomy and reconstruction and not a solely cosmetic procedure)</li><li>For detection of occult breast cancer in the setting of axillary nodal adenocarcinoma with negative physical exam and negative mammography</li><li>For presurgical planning of locally, advanced breast cancer (before and after completion of neoadjuvant chemotherapy) to permit tumor localization and characterization</li><li>For presurgical planning to evaluate the presence of multicentric disease in patients with localized or locally, advanced breast cancer who are candidates for breast-conservation treatment</li><li>To evaluate suspected cancer recurrence</li><li>To determine the presence of pectoralis major-/minor- muscle, chest-wall invasion in patients with a posteriorly located tumor</li><li>For guidance of interventional procedures such as vacuum-assisted biopsy and preoperative wire localization for lesions that are occult on mammography or sonography and are demonstrable only with MRI</li></ul> 1966<p> </p> 1967<p>Other indications may be covered when Humana Military determines it to be medically necessary and appropriate.</p> 1968<p> </p> 1969<h4><b>Exclusions</b></h4> 1970<p>MRIs: CPT codes<b> </b>77046-77047</p> 1971<p> </p> 1972<p>MRIs are excluded from coverage for the following indications:</p> 1973<ul><li>To screen for breast cancer in asymptomatic women considered to be at low or average risk</li><li>For diagnosis of suspicious lesions to avoid biopsy</li><li>To evaluate response to neoadjuvant chemotherapy</li><li>To differentiate cysts from solid lesions</li><li>To assess implant integrity or confirm implant rupture, if implants were not originally covered or coverable</li></ul> 1974<p> </p> 1975<h5>MRIs and implant assessment: CPT code<b> </b>77058<b></b></h5> 1976<p>MRIs are excluded for assessment of implant integrity or to confirm implant rupture, if implants were not originally covered or coverable.</p> 1977<p> </p> 1978<h5>Computer-Aided Detection: CPT codes 77048-77049<b></b></h5> 1979<p>CAD with breast MRI is unproven and excluded from coverage.</p> 1980<p> </p> 1981<h5>Genetics and genetic counseling: CPT code 96041</h5> 1982<p>Medical genetics and genetic counseling services (30 minutes) from genetic counselors who are not TRICARE-authorized providers are excluded from coverage. </p> 1983<p> </p> 1984<p>See <a data-ispdf="false" data-iscta="false" href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2024-12-17/AsOf/TOT5/C18S3.html" target="_blank" rel="noopener noreferrer">TRICARE Operations Manual (TOM), Ch. 18, Sec. 3 and Sec. 9</a>.</p> 1985 1986 </div> 1987 <div class="mi-article-cards__content-cta-wrap"> 1988 <div slot="cta"> 1989 1990 1991 1992 </div> 1993 </div> 1994</div></div> 1995<div class="richText text"> 1996<div data-cmp-data-layer="{"20250909-HypertrophicScarring":{"xdm:text":"&nbsp;&nbsp;","@type":"humana-military-com/components/richText","@id":"20250909-HypertrophicScarring","repo:modifyDate":"2025-09-09T15:45:23Z"}}" id="20250909-HypertrophicScarring" class="cmp-text"> 1997 <p>  </p> 1998 1999</div> 2000 2001 2002 2003</div> 2004<div class="card"> 2005 2006 2007<div class="mi-article-cards__wrapper "> 2008 <div class="mi-article-cards__img-wrap"> 2009 <img/> 2010 </div> 2011 <div class="mi-article-cards__content-txt"> 2012 <h3 class="mi-article-cards__content-txt-title"> 2013 New covered treatment for hypertrophic scarring and keloids 2014 </h3> 2015 <div class="mi-article-cards__content-txt-eyebro-txt"> September 9, 2025</div> 2016 <p>TRICARE made recent updates to covered services for the treatment of hypertrophic scarring and keloids. Those that result from burns, surgical procedures or traumatic events are covered as cost-share only with evidence of impaired function. Previously, only topical treatments were covered. </p> 2017<p> </p> 2018<p>See <a data-ispdf="false" data-iscta="false" href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2024-12-17/AsOf/TOT5/C18S3.html" target="_blank" rel="noopener noreferrer">TRICARE Operations Manual (TOM), Ch. 18, Sec. 3 and Sec. 9</a>.</p> 2019 2020 </div> 2021 <div class="mi-article-cards__content-cta-wrap"> 2022 <div slot="cta"> 2023 2024 2025 2026 </div> 2027 </div> 2028</div></div> 2029<div class="richText text"> 2030<div data-cmp-data-layer="{"20250908-DBTBCS":{"xdm:text":"&nbsp;&nbsp;","@type":"humana-military-com/components/richText","@id":"20250908-DBTBCS","repo:modifyDate":"2025-10-22T19:55:51Z"}}" id="20250908-DBTBCS" class="cmp-text"> 2031 <p>  </p> 2032 2033</div> 2034 2035 2036 2037</div> 2038<div class="card"> 2039 2040 2041<div class="mi-article-cards__wrapper "> 2042 <div class="mi-article-cards__img-wrap"> 2043 <img/> 2044 </div> 2045 <div class="mi-article-cards__content-txt"> 2046 <h3 class="mi-article-cards__content-txt-title"> 2047 Digital Breast Tomosynthesis for Breast Cancer Screening 2048 </h3> 2049 <div class="mi-article-cards__content-txt-eyebro-txt"> September 8, 2025</div> 2050 <p>This change removes frequency limitations and makes digital breast tomosynthesis, also known as DBT or 3D mammography, a covered clinical preventive services benefit for breast cancer screening for eligible TRICARE beneficiaries.</p> 2051<p> </p> 2052<p>Screening mammography, whether digital mammography or Digital Breast Tomosynthesis (DBT) (3D mammography), is covered for all persons assigned female at birth between the ages of 40 and 74 who are at an average or increased risk of breast cancer. The frequency of breast cancer screening may be at the discretion of the patient and the clinician; however, screening mammography should not be performed less frequently than once every two years. For patients 75 and older, screening mammography will be at the discretion of the patient and physician.</p> 2053<p><br /> 2054See more at: <a href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2025-07-31/AsOf/TPT5/C7S2_1.html" target="_blank" data-ispdf="false" data-iscta="false" rel="noopener noreferrer">TRICARE Policy Manual (TPM), Ch. 7, Sec. 2.1.</a></p> 2055 2056 </div> 2057 <div class="mi-article-cards__content-cta-wrap"> 2058 <div slot="cta"> 2059 2060 2061 2062 </div> 2063 </div> 2064</div></div> 2065<div class="richText text"> 2066<div data-cmp-data-layer="{"20250821-Appeals":{"xdm:text":"&nbsp;&nbsp;","@type":"humana-military-com/components/richText","@id":"20250821-Appeals","repo:modifyDate":"2025-08-26T12:11:52Z"}}" id="20250821-Appeals" class="cmp-text"> 2067 <p>  </p> 2068 2069</div> 2070 2071 2072 2073</div> 2074<div class="card"> 2075 2076 2077<div class="mi-article-cards__wrapper "> 2078 <div class="mi-article-cards__img-wrap"> 2079 <img/> 2080 </div> 2081 <div class="mi-article-cards__content-txt"> 2082 <h3 class="mi-article-cards__content-txt-title"> 2083 Make sure your appeals process correctly! 2084 </h3> 2085 <div class="mi-article-cards__content-txt-eyebro-txt"> August 21, 2025</div> 2086 <p>Appeals and allowable charge reviews are different types of requests related to denials and payment amounts. To more accurately and efficie
2086ntly process these types of requests, we are providing clarity regarding the definitions of each and where written requests should be submitted.</p> 2087<p> </p> 2088<p><b>Allowable charge reviews (non-appealable)</b></p> 2089<p>The following are considered non-appealable issues:</p> 2090<ul><li>Allowed amount disputes</li><li>Charges denied for insufficient information due or requested information not received</li><li>Coding issues</li><li>Cost-share and deductible issues</li><li>Eligibility denials</li><li>Other Health Insurance (OHI) issues</li><li>Penalties for no authorization</li><li>Third Party Liability (TPL) issues</li><li>Timely filing denials</li><li>Wrong procedure code<br /> 2091<br /> 2092</li></ul> 2093<p>Written requests for allowable charge reviews related to the above issues should be submitted using one of the following methods:</p> 2094<p> </p> 2095<p>By fax: (877) 489-0011</p> 2096<p> </p> 2097<p>By mail at:</p> 2098<p>Humana Military</p> 2099<p>PO Box 202146</p> 2100<p>Florence, SC 29502-2146</p> 2101<p> </p> 2102<p><b>Appeals</b></p> 2103<p>Appeals are outlined in TRICARE Operations Manual (TOM) Ch. 12 and are limited to the following:</p> 2104<ul><li>Authorization or claims that denied as a non-covered benefit</li><li>Authorization or claims denied as not a medical necessary</li><li>Point of Service (POS) charges related to an emergency service</li></ul> 2105<p><br /> 2106Appeals must be submitted using one of the following methods:</p> 2107<p>Electronically (preferred method), see <a href="https://infocenter.humana-military.com/appeals/?path=authorization" target="_blank" data-ispdf="false" data-iscta="false" rel="noopener noreferrer">Appeal authorization</a> or <a href="https://infocenter.humana-military.com/appeals/?path=claims" target="_blank" data-ispdf="false" data-iscta="false" rel="noopener noreferrer">Appeal denied claim</a>.<br /> 2108<br /> 2109<br /> 2110</p> 2111<p>By fax: (877) 850-1046</p> 2112<p> </p> 2113<p>By mail at:</p> 2114<p>Humana Military appeals<br /> 2115PO Box 740044<br /> 2116Louisville, KY 40201-7444</p> 2117<p> </p> 2118<p>Find out more about <a href="https://www.humanamilitary.com/appeal" target="_self" data-ispdf="false" data-iscta="false" rel="noopener noreferrer">appealable issues</a>, or see <a href="https://www.humanamilitary.com/content/dam/sites/humana-military-com/provider/faqs/appeal-submission-process-faqs.pdf" target="_blank" data-ispdf="true" data-iscta="false" rel="noopener noreferrer">Appeal submission process FAQs</a>.</p> 2119<p> </p> 2120<p><b>Appeals must be submitted by a  proper appealing party, which includes:</b></p> 2121<ul><li>The patient, any age.</li><li>The parent or guardian of a patient under age 18 (except sensitive diagnosis claims).</li><li>A non-network participating provider of services</li><li>A non-network provider appealing a preadmission or preprocedural denial (when services have not been rendered)</li><li>The  person appointed by the beneficiary as a representative using a completed <a href="https://www.humanamilitary.com/content/dam/sites/humana-military-com/beneficiary-section/forms/appointment-of-representative-v2.pdf" target="_blank" data-ispdf="true" data-iscta="false" rel="noopener noreferrer">appointment of Appeal Representative (AOR) form</a>.<b></b></li></ul> 2122<p><b> </b></p> 2123<p><b>Appointed representatives MAY include:</b></p> 2124<ul><li>Spouse, parent or legal guardian</li><li>A non-network participating provider may submit an appeal acting on behalf of the beneficiary but must have a signed AOR by the beneficiary specific to the appeal being requested</li><li>The legal representative of the estate of a deceased beneficiary</li><li>An attorney acting on behalf of an otherwise proper appealing party listed above</li></ul> 2125 2126 </div> 2127 <div class="mi-article-cards__content-cta-wrap"> 2128 <div slot="cta"> 2129 2130 2131 2132 </div> 2133 </div> 2134</div></div> 2135<div class="richText text"> 2136<div data-cmp-data-layer="{"20250813-MRTSB":{"xdm:text":"&nbsp;&nbsp;","@type":"humana-military-com/components/richText","@id":"20250813-MRTSB","repo:modifyDate":"2025-08-26T12:10:59Z"}}" id="20250813-MRTSB" class="cmp-text"> 2137 <p>  </p> 2138 2139</div> 2140 2141 2142 2143</div> 2144<div class="card"> 2145 2146 2147<div class="mi-article-cards__wrapper "> 2148 <div class="mi-article-cards__img-wrap"> 2149 <img/> 2150 </div> 2151 <div class="mi-article-cards__content-txt"> 2152 <h3 class="mi-article-cards__content-txt-title"> 2153 Safety beds clarification 2154 </h3> 2155 <div class="mi-article-cards__content-txt-eyebro-txt"> August 13, 2025</div> 2156 <p>TRICARE policy recently clarified that safety beds are a convenience item and not a medical item and therefore cannot be covered under TRICARE.</p> 2157<p> </p> 2158<p>
2158Beds that are not medical in nature and used for comfort or convenience (e.g., power or manual lounge beds, sleep-number beds, ordinary beds typically sold as furniture) are excluded. Additionally, safety beds or sleep safe beds that are designed to prevent falls and protect individuals from entanglement and entrapment while in the bed (e.g., Beds by George Haven, Cubby beds) and all accompanying accessories are excluded.</p> 2159<p><br /> 2160TRICARE doesnât cover safety medical supplies, such as bath or toilet rails, safety beds, helmets and childproof locks.</p> 2161<p> </p> 2162<p>For more information, visit <a href="https://manuals.health.mil/pages/PublishedChange.aspx?manual=TPT5&change=29" target="_blank" data-ispdf="false" data-iscta="false" rel="noopener noreferrer">Change 29 in TRICARE Policy Manual (TPM)</a> or <a></a><a href="https://tricare.mil/CoveredServices/IsItCovered/SafetyMedicalSupplies" target="_blank" data-ispdf="false" data-iscta="false" rel="noopener noreferrer">Safety Medical Supplies</a>.</p> 2163 2164 </div> 2165 <div class="mi-article-cards__content-cta-wrap"> 2166 <div slot="cta"> 2167 2168 2169 2170 </div> 2171 </div> 2172</div></div> 2173<div class="richText text"> 2174<div data-cmp-data-layer="{"20250804-CMNS":{"xdm:text":"&nbsp;&nbsp;","@type":"humana-military-com/components/richText","@id":"20250804-CMNS","repo:modifyDate":"2025-08-04T19:30:33Z"}}" id="20250804-CMNS" class="cmp-text"> 2175 <p>  </p> 2176 2177</div> 2178 2179 2180 2181</div> 2182<div class="container responsivegrid"> 2183 2184 2185 2186 2187 <div id="container-7d1f8b67fb" class="cmp-container"> 2188 2189 <div class="card"> 2190 2191 2192<div class="mi-article-cards__wrapper "> 2193 <div class="mi-article-cards__img-wrap"> 2194 <img/> 2195 </div> 2196 <div class="mi-article-cards__content-txt"> 2197 <h3 class="mi-article-cards__content-txt-title"> 2198 Certificate of Medical Necessity (CMN) processing update 2199 </h3> 2200 <div class="mi-article-cards__content-txt-eyebro-txt"> August 4, 2025</div> 2201 <p><b>January 1, 2026 update</b></p> 2202<p>As of January 1, 2026, the 90-day waiting period for submitting a CMN no longer applies.</p> 2203<p> </p> 2204<p><b>August 4, 2025 update</b></p> 2205<p>Please allow up to 90 days from the date you submit the CMN before resubmitting duplicate documentation. This gives us time to enter the forms into the system and make any needed corrections to claims.</p> 2206 2207 </div> 2208 <div class="mi-article-cards__content-cta-wrap"> 2209 <div slot="cta"> 2210 2211 2212 2213 </div> 2214 </div> 2215</div></div> 2216<div class="richText text"> 2217<div data-cmp-data-layer="{"text-e879387996":{"xdm:text":"&nbsp;&nbsp;","@type":"humana-military-com/components/richText","@id":"text-e879387996","repo:modifyDate":"2025-08-04T19:28:34Z"}}" id="richText-e879387996" class="cmp-text"> 2218 <p>  </p> 2219 2220</div> 2221 2222 2223 2224</div> 2225 2226 2227 </div> 2228 2229</div> 2230<div class="card"> 2231 2232 2233<div class="mi-article-cards__wrapper "> 2234 <div class="mi-article-cards__img-wrap"> 2235 <img/> 2236 </div> 2237 <div class="mi-article-cards__content-txt"> 2238 <h3 class="mi-article-cards__content-txt-title"> 2239 Changes to Autism Care Demonstration (ACD) audits 2240 </h3> 2241 <div class="mi-article-cards__content-txt-eyebro-txt"> July 24, 2025</div> 2242 <p>Per <a data-ispdf="false" data-iscta="false" href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2025-01-17/AsOf/TOT5/C18S3.html" target="_blank" rel="noopener noreferrer">TRICARE policy</a>, Humana Military conducts annual provider audits for ACD services. Please see the updated contractual requirements you need to be aware of:  </p> 2243<p> </p> 2244<h4>Applied Behavioral Analysis (ABA) Quality Monitoring and Oversight </h4> 2245<p><b>8.9.2</b> The contractor shall conduct, on an annual basis, an audit, which includes a minimum of 30 records for each ACD-Corporate Services Providers (ASCP)/Sole Provider group that include a combination of administrative records <a data-ispdf="false" data-iscta="false" href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2025-01-17/AsOf/TOT5/C18S3.html#BABDJFJHD5" target="_blank" rel="noopener noreferrer">(Para. 8.9.7)</a> and medical documentation <a data-ispdf="false" data-iscta="false" href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2025-01-17/AsOf/TOT5/C18S3.html#BABIDGCJA3" target="_blank" rel="noopener noreferrer">(Para. 8.9.8)</a> reviews and one MTC session note.</p> 2246<p> </p> 2247<h4>New ACSP/Sole Provider Review</h4> 2248<p><b>8.9.9.2</b> The contractor shall conduct a probe audit sample (see <a data-ispdf="false" data-iscta="false" href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2025-01-17/AsOf/TOT5/c13s3.html#FM63551" target="_blank" rel="noopener noreferrer">Ch. 13, Sec. 3</a>) following 180 calendar days of participation in the program to review clinical documentation and claims submission for consistency with program requirements.</p> 2249<p> </p> 2250<h4>ABA Quality Monitoring and Oversight</h4> 2251<p><b>8.9.5</b> The contractor shall initiate progressively more severe administration action, commensurate with the seriousness of the identified problems, and consistent with <a data-ispdf="false" data-iscta="false" href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2025-01-17/AsOf/TOT5/c13toc.html" target="_blank" rel="noopener noreferrer">
2251Ch. 13</a> and <a data-ispdf="false" data-iscta="false" href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2025-01-17/AsOf/fr16/c9.html" target="_blank" rel="noopener noreferrer">32 CFR 199.9</a>.</p> 2252<p> </p> 2253<h4>Annual Reviews</h4> 2254<p><b>8.9.10</b> The contractor shall conduct an annual audit of a statistically valid number of providers, to include collecting proof of documentation (either through source verification or actual document), to ensure ABA providers meet the requirements set forth in <a data-ispdf="false" data-iscta="false" href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2025-01-17/AsOf/TOT5/C18S3.html#BABIHIJIG5" target="_blank" rel="noopener noreferrer">Para. 8.2</a> through <a data-ispdf="false" data-iscta="false" href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2025-01-17/AsOf/TOT5/C18S3.html#BABCHHJED1" target="_blank" rel="noopener noreferrer">8.4</a>.</p> 2255<p> </p> 2256<h4>Impacts from audit changes </h4> 2257<p>Based on the policy outlined in <a data-ispdf="false" data-iscta="false" href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2025-01-17/AsOf/TOT5/C18S3.html" target="_blank" rel="noopener noreferrer">TOM Ch. 18, Sec. 3, Para. 8.11.7.5</a> and <a data-ispdf="false" data-iscta="false" href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2025-01-17/AsOf/TOT5/C18S3.html" target="_blank" rel="noopener noreferrer">8.11.7.6</a>, and the new capabilities to identify concurrent billing in the new contract, we have seen a significant number of audits (75%+) in which claims are shifting from paid to a denied status. </p> 2258<p> </p> 2259<p>As a result, these impacted claims must be removed from the audit, which impacts our ability to meet the requirement of auditing 30 claimsâor all paid claims when fewer than 30 are submitted in a year. </p> 2260<p> </p> 2261<p><b>To prevent the cancellation of audits when medical records were already submitted, we made the difficult decision to increase the number of claims included in an audit to up to 35 annually</b>, allowing us to meet the minimum requirement outlined in the TOM. If we see a decrease in concurrent billing in the future, we have the ability to lower the required medical records threshold closer to the minimum required.</p> 2262<p> </p> 2263<p>Please note the additional audit and claims impacts below: </p> 2264<ul><li>All claims determined to be insufficient for claims payment will result in recoupment. </li><li>Medical records not returned in the audit as requested will result in recoupment.</li><li>Failure to pass the annual audit will result in a monitoring audit.</li><li>Failure of the monitoring audit or non-compliance in responding to the request for medical records will result in prepayment review. </li></ul> 2265<p> </p> 2266<p>Please contact us at <a data-ispdf="false" data-iscta="false" href="mailto:HMACDProviderInquiries@HumanaMilitary.com">HMACDProviderInquiries@HumanaMilitary.com</a> with any questions. </p> 2267<p> </p> 2268<p>Thank you for serving our beneficiaries and for your review of the requirements to ensure your team remains compliant with TRICARE policy. </p> 2269<p> </p> 2270<p>Humana Military</p> 2271 2272 </div> 2273 <div class="mi-article-cards__content-cta-wrap"> 2274 <div slot="cta"> 2275 2276 2277 2278 </div> 2279 </div> 2280</div></div> 2281<div class="richText text"> 2282<div data-cmp-data-layer="{"20250717-TRICAREpolicy":{"xdm:text":"&nbsp;&nbsp;","@type":"humana-military-com/components/richText","@id":"20250717-TRICAREpolicy","repo:modifyDate":"2025-07-28T17:02:02Z"}}" id="20250717-TRICAREpolicy" class="cmp-text"> 2283 <p>  </p> 2284 2285</div> 2286 2287 2288 2289</div> 2290<div class="card"> 2291 2292 2293<div class="mi-article-cards__wrapper "> 2294 <div class="mi-article-cards__img-wrap"> 2295 <img/> 2296 </div> 2297 <div class="mi-article-cards__content-txt"> 2298 <h3 class="mi-article-cards__content-txt-title"> 2299 Follow TRICARE policy when making referrals to specialists 2300 </h3> 2301 <div class="mi-article-cards__content-txt-eyebro-txt"> July 17, 2025</div> 2302 <p>Please note that while you may submit a referral for specialty care, the beneficiaryâs local military hospital or clinic will review the request according to TRICARE policy. At that point, the military hospital or clinical have the Right of First Refusal (ROFR) and may refer the beneficiary to a civilian network provider.</p> 2303<p> </p> 2304<h4>What is ROFR?</h4> 2305<p><a href="https://www.humanamilitary.com/provider/refsauths" data-ispdf="false" data-iscta="false">ROFR</a> allows military hospitals and clinics the opportunity to review and assign specialized care. If the hospital or clinic canât provide the services or care requested, then the beneficiary will be referred to a civilian network provider.</p> 2306<p> </p> 2307<p>How can I keep the referral process working smoothly?</p> 2308<ul><li>Remember that local military hospitals and clinics determine specialists, not Humana Military.</li><li>Inform beneficiaries that they canât request specific specialists or make a change request after the ROFR determination is made.</li><li>Build or request referrals using the options available through <a href="https://infocenter.humana-military.com/prov/service/Account/Login" target="_blank" data-ispdf="false" data-iscta="false" rel="noopener noreferrer">Provider self-service</a>.</li><li>Understand that even if you select a provider to refer to, the local military hospital or clinic may review and override the referral selection, applying the ROFR.</li><li>Inform beneficiary that once the military hospital or clinic accepts the referral, Humana Military will not authorize any provider changes. If the facility canât provide the care and releases the referral back to the civilian provider network, then the beneficiary may request a change.</li></ul> 2309<p> </p> 2310<p><b>Important note:</b> Bypassing this process has a significant financial impact on beneficiaries. If they choose to go outside the referral process, they will use their Point of Service (POS) option. If they receive specialty care from a provider that Humana Military has not authorized, they will incur additional costs at 50% of the TRICARE allowable charge after their deductible has been met for the entire episode of care. </p> 2311<p> </p> 2312<p><b>Read more in the <a href="https://www.humanamilitary.com/content/dam/sites/humana-military-com/provider/faqs/Provider-referral-authorization.pdf" target="_blank" data-ispdf="true" data-iscta="false" rel="noopener noreferrer">ROFR FAQs</a> or visit <a href="https://www.humanamilitary.com/provider/refsauths" data-ispdf="true" data-iscta="false">Referrals and Authorizations | Humana Military</a>.</b></p> 2313 2314 </div> 2315 <div class="mi-article-cards__content-cta-wrap"> 2316 <div slot="cta"> 2317 2318 2319 2320 </div> 2321 </div> 2322</div></div> 2323<div class="richText text"> 2324<div data-cmp-data-layer="{"
2324text-e30d6b0a68":{"xdm:text":"&nbsp;&nbsp;","@type":"humana-military-com/components/richText","@id":"text-e30d6b0a68","repo:modifyDate":"2024-04-09T16:51:04Z"}}" id="richText-e30d6b0a68" class="cmp-text"> 2325 <p>  </p> 2326 2327</div> 2328 2329 2330 2331</div> 2332<div class="card"> 2333 2334 2335<div class="mi-article-cards__wrapper "> 2336 <div class="mi-article-cards__img-wrap"> 2337 <img/> 2338 </div> 2339 <div class="mi-article-cards__content-txt"> 2340 <h3 class="mi-article-cards__content-txt-title"> 2341 New code editing rules for diabetic supply codes 2342 </h3> 2343 <div class="mi-article-cards__content-txt-eyebro-txt"> July 14, 2025</div> 2344 <p>Providers must indicate if the supply code is for insulin-dependent or non-insulin-dependent types. The modifier KX (insulin) or KS (non-insulin) is used to distinguish between the two. While the modifier requirement is unique to Medicare, the allowed frequencies are based on industry standard packaging practices and derived from various health plan policies.</p> 2345<p> </p> 2346<p>Please see the below codes for reference:</p> 2347<p>KX â (insulin)</p> 2348<p>KS â (non-insulin)</p> 2349<p> </p> 2350<p>For example, with a traditional tethered insulin pump, you will need to change the infusion set (which includes the needle) every two to three days. This means you will l need approximately 10 to 15 sets per month. Tubeless pumps, such as the Omnipod, also require a new set every two to three days.</p> 2351<p> </p> 2352<p>The HCPCS code A4230 refers to "Infusion set for external insulin pump, non-needle cannula type." This code does not specify a particular manufacturer or packaging, so the number of infusion sets per box may vary by supplier and product brand. Most commercial infusion set boxes contain 10 sets per box.</p> 2353 2354 </div> 2355 <div class="mi-article-cards__content-cta-wrap"> 2356 <div slot="cta"> 2357 2358 2359 2360 </div> 2361 </div> 2362</div></div> 2363<div class="richText text"> 2364<div data-cmp-data-layer="{"text-a3a2ba9ddd":{"xdm:text":"&nbsp;&nbsp;","@type":"humana-military-com/components/richText","@id":"text-a3a2ba9ddd","repo:modifyDate":"2024-04-09T16:51:04Z"}}" id="richText-a3a2ba9ddd" class="cmp-text"> 2365 <p>  </p> 2366 2367</div> 2368 2369 2370 2371</div> 2372<div class="card"> 2373 2374 2375<div class="mi-article-cards__wrapper "> 2376 <div class="mi-article-cards__img-wrap"> 2377 <img/> 2378 </div> 2379 <div class="mi-article-cards__content-txt"> 2380 <h3 class="mi-article-cards__content-txt-title"> 2381 Q3 TRICARE reimbursement implementation update 2382 </h3> 2383 <div class="mi-article-cards__content-txt-eyebro-txt"> July 1, 2025</div> 2384 <p>Humana Military is actively processing claims while we are implementing the following quarterly reimbursement updates. During this process, claims status may be temporarily set to pending, and claims payments will resume once the implementation is complete.</p> 2385<p> </p> 2386<ul><li>Outpatient Prospective Payment System (OPPS)</li><li>Outpatient Code Editor (OCE)</li><li>
2386Ambulatory Surgery Center (ASC)</li><li>CMS Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS)</li><li>Long-Term Care Hospital (LTCH)</li><li>Skilled Nursing Facility (SNF)</li></ul> 2387 2388 </div> 2389 <div class="mi-article-cards__content-cta-wrap"> 2390 <div slot="cta"> 2391 2392 2393 2394 </div> 2395 </div> 2396</div></div> 2397<div class="richText text"> 2398<div data-cmp-data-layer="{"20250618-MFA":{"xdm:text":"&nbsp;&nbsp;","@type":"humana-military-com/components/richText","@id":"20250618-MFA","repo:modifyDate":"2025-07-29T18:08:33Z"}}" id="20250618-MFA" class="cmp-text"> 2399 <p>  </p> 2400 2401</div> 2402 2403 2404 2405</div> 2406<div class="card"> 2407 2408 2409<div class="mi-article-cards__wrapper "> 2410 <div class="mi-article-cards__img-wrap"> 2411 <img/> 2412 </div> 2413 <div class="mi-article-cards__content-txt"> 2414 <h3 class="mi-article-cards__content-txt-title"> 2415 Coming soon: Enhanced security for your self-service account 2416 </h3> 2417 <div class="mi-article-cards__content-txt-eyebro-txt"> June 18, 2025</div> 2418 <p>Humana Military's provider self-service is moving to a more secure login. Users will soon notice an extra step to verify your identity, in addition to your password. This enhanced security feature adds another layer of protection.</p> 2419<p><br /> 2420In <a href="https://infocenter.humana-military.com/prov/service/Account/Login" title="https://infocenter.humana-military.com/prov/service/Account/Login" target="_blank" data-ispdf="false" data-iscta="false" rel="noopener noreferrer">provider self-service</a>, every user must have their own account with a unique email address and user ID. Each user will only have one user ID as part of enhancements to Humana Military's user security protocols. If your self-service account currently uses a shared email to log in, it will no longer meet our updated login requirements. If you have a shared email to login, you will need to update your email in the "My User Profile" section of selfâservice (link to self-service) by July 18, 2025, to avoid losing access.</p> 2421<ul><li>Currently single User ID to single TIN:<ul><li>Please review your active user IDs and determine which one to keep.  </li><li>The next step will be to add any TINs from the other User IDs to your active account. <b>In provider self-service, click on the "Add TIN/EIN to my self-service account</b>" link and follow the prompts.</li><li>Please select best approval option by hovering over learn more once the verification method pops up<b>. </b></li><li>Please note that once additional TINs are added to your provider self-service account, you can easily change TINs by clicking the box with Group/Facility/Provider name and TIN.</li></ul> 2422</li><li>Multiple users with same email:<ul><li>Update email under âMy Profileâ</li><li>If you received the error, âEmail <a href="mailto:xxxxx@yahoo.com">xxxxx@yahoo.com</a> is unavailable. Please try another Emailâ, the email is already used by another User ID, please update to a unique email.</li></ul> 2423</li></ul> 2424<p> </p> 2425<p>If you have any questions, please contact us in selfâservice through the secure messaging or chat feature or <a data-ispdf="false" data-iscta="false" href="https://www.humanamilitary.com/faq" target="_self" rel="noopener noreferrer">visit our FAQ page</a>.</p> 2426 2427 </div> 2428 <div class="mi-article-cards__content-cta-wrap"> 2429 <div slot="cta"> 2430 2431 2432 2433 </div> 2434 </div> 2435</div></div> 2436<div class="richText text"> 2437<div data-cmp-data-layer="{"text-1727a2c8c0":{"xdm:text":"&nbsp;&nbsp;","@type":"humana-military-com/components/richText","@id":"text-1727a2c8c0","repo:modifyDate":"2024-04-09T16:51:04Z"}}" id="richText-1727a2c8c0" class="cmp-text"> 2438 <p>  </p> 2439 2440</div> 2441 2442 2443 2444</div> 2445<div class="card"> 2446 2447 2448<div class="mi-article-cards__wrapper "> 2449 <div class="mi-article-cards__img-wrap"> 2450 <img/> 2451 </div> 2452 <div class="mi-article-cards__content-txt"> 2453 <h3 class="mi-article-cards__content-txt-title"> 2454 Update on applying for EFT payments 2455 </h3> 2456 <div class="mi-article-cards__content-txt-eyebro-txt"> June 17, 2025</div> 2457 <p>To avoid delays and ensure timely processing, submit your applications for EFT. Here are some tips to ensure yours is processed as quickly as possible:</p> 2458<ul><li>Only submit an application once. Submitting multiple applications for the same provider will slow down the application approval process.</li><li>Include the required bank letter OR a voided check with the application. If this is not submitted, the application will be returned requesting the information. The application will not be processed until this item is submitted.</li></ul> 2459<p> </p> 2460<p>After a provider completes a submission, they will receive a response saying the request was received (if submitted online or by email). Once the application is processed, PGBA will send a confirmation letter that enrollment is complete. EFT enrollments submitted by fax or mail will receive a submission confirmation in the method the application was made. <a data-ispdf="true" data-iscta="false" href="https://www.humanamilitary.com/content/dam/sites/humana-military-com/provider/forms/miscellaneous/eft-and-era-enrollment-package.pdf" target="_blank" rel="noopener noreferrer">Complete the EFT application</a>.</p> 2461 2462 </div> 2463 <div class="mi-article-cards__content-cta-wrap"> 2464 <div slot="cta"> 2465 2466 2467 2468 </div> 2469 </div> 2470</div></div> 2471<div class="richText text"> 2472<div data-cmp-data-layer="{"text-ce33ca7fcb":{"xdm:text":"&nbsp;&nbsp;","@type":"humana-military-com/components/richText","@id":"text-ce33ca7fcb","repo:modifyDate":"2024-04-09T16:51:04Z"}}" id="richText-ce33ca7fcb" class="cmp-text"> 2473 <p>  </p> 2474 2475</div> 2476 2477 2478 2479</div> 2480<div class="card"> 2481 2482 2483<div class="mi-article-cards__wrapper "> 2484 <div class="mi-article-cards__img-wrap"> 2485 <img/> 2486 </div> 2487 <div class="mi-article-cards__content-txt"> 2488 <h3 class="mi-article-cards__content-txt-title"> 2489 Updated guidance on treatment for Gender Dysphoria (GD) 2490 </h3> 2491 <div class="mi-article-cards__content-txt-eyebro-txt"> June 16, 2025</div> 2492 <p>A new memorandum from the assistant secretary of defense for health affairs, âAdditional guidance on treatment of gender dysphoria,â refers to the executive order 14183, âPrioritizing military excellence and readiness,â and denies any service memberâs referrals or requests for private-sector care for all unscheduled, scheduled or planned surgical procedures associated with sex reassignment, effective May 9, 2025. </p> 2493<p> </p> 2494<p>This applies to service members diagnosed with GD; surgical evaluations for Gender Affirming Surgery (GAS); and newly initiated cross-sex hormone therapy as treatment for GD, unless a new, approved waiver from the Office of the Assistant Secretary of Defense for Health Affairs, known as ASD(HA), is received.  </p> 2495<p> </p> 2496<p>Claims for the following services that have a date of service before May 9, 2025, may be processed and paid: authorized, cross-sex hormone therapy; surgical evaluations for GAS; and GAS procedures for service members diagnosed with GD. </p> 2497<p> </p> 2498<p>All previously approved Supplemental Health Care Program (SHCP) waivers for surgical care are cancelled. However, new SHCP waiver requests for medically necessary care to address surgical complications and necessary repairs may be submitted for review by the office of the ASD(HA).</p> 2499<p> </p> 2500<p>Changes to the TRICARE manuals will be issued later. </p> 2501 2502 </div> 2503 <div class="mi-article-cards__content-cta-wrap"> 2504 <div slot="cta"> 2505 2506 2507 2508 </div> 2509 </div> 2510</div></div> 2511<div class="richText text"> 2512<div data-cmp-data-layer="{"text-83f77c2e42":{"xdm:text":"&nbsp;&nbsp;","@type":"humana-military-com/components/richText","@id":"text-83f77c2e42","repo:modifyDate":"2024-04-09T16:51:04Z"}}" id="richText-83f77c2e42" class="cmp-text"> 2513 <p>  </p> 2514 2515</div> 2516 2517 2518 2519</div> 2520<div class="card"> 2521 2522 2523<div class="mi-article-cards__wrapper "> 2524 <div class="mi-article-cards__img-wrap"> 2525 <img/> 2526 </div> 2527 <div class="mi-article-cards__content-txt"> 2528 <h3 class="mi-article-cards__content-txt-title"> 2529 Organ acquisition rates request update 2530 </h3> 2531 <div class="mi-article-cards__content-txt-eyebro-txt"> June 5, 2025</div> 2532 <p>Effective Oct. 28, 2019, TRICARE offers reimbursement for reasonable and necessary organ acquisition services and costs in support of quality organ transplant programs. Under Medicare, Certified Transplant Centers (CTC) and Organ Procurement Organizations (OPO) report these costs using the Centers for Medicare and Medicaid Services (CMS) Forms 2552 and 216. TRICARE will use the Medicare Standard Acquisition Charges (SAC) to determine reimbursement amounts.</p> 2533<p> </p> 2534<p>Humana Military is tasked each year with surveying all hospitals that had an organ acquisition cost and providing this information to the Defense Health Agency (DHA) for the TRICARE East Region. </p> 2535<p> </p> 2536<p>To remain compliant, providers should return the following documents before July 31, 2025:</p> 2537<p>⢠A completed <a data-ispdf="true" data-iscta="false" href="https://www.humanamilitary.com/content/dam/sites/humana-military-com/provider/forms/sac-for-organ-acquisition.pdf" target="_blank" rel="noopener noreferrer">Standard Acquisition Charges (SAC) for organ acquisition form</a>  </p> 2538<p>⢠The most recent SAC rate reported to Medicare </p> 2539<p> </p> 2540<p>Please use the form referenced above and <b>do not submit D-4 worksheets</b>. </p> 2541<p> </p> 2542<p><b>Please note: the address submitted on the form will be used for the annual correspondence for SAC rates.</b></p> 2543<p> </p> 2544<p>Failure to return this information will result in TRICAREâs use of a provider facilityâs overall operation cost-to-charge ratio to reduce charges, per <a data-ispdf="false" data-iscta="false" href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2022-12-05/AsOf/TRT5/C1S40.html" target="_blank" rel="noopener noreferrer">TRICARE Reimbursement Manual (TRM)</a>. If a facility does not have any SAC rates for the year, providers should provide an explanation.</p> 2545<p> </p> 2546<p>Please return the required information, including any relevant point of contact to <a data-ispdf="false" data-iscta="false" href="mailto:HMHSPricingMailbox@HumanaMilitary.com">HMHSPricingMailbox@HumanaMilitary.com</a>. </p> 2547 2548 </div> 2549 <div class="mi-article-cards__content-cta-wrap"> 2550 <div slot="cta"> 2551 2552 2553 2554 </div> 2555 </div> 2556</div></div> 2557<div class="richText text"> 2558<div data-cmp-data-layer="{"20250514-BetterDoctor":{"xdm:text":"&nbsp;&nbsp;","@type":"humana-military-com/components/richText","@id":"20250514-BetterDoctor","repo:modifyDate":"2025-12-02T13:31:47Z"}}" id="20250514-BetterDoctor" class="cmp-text"> 2559 <p>  </p> 2560 2561</div> 2562 2563 2564 2565</div> 2566<div class="card"> 2567 2568 2569<div class="mi-article-cards__wrapper "> 2570 <div class="mi-article-cards__img-wrap"> 2571 <img/> 2572 </div> 2573 <div class="mi-article-cards__content-txt"> 2574 <h3 class="mi-article-cards__content-txt-title"> 2575 A tool to enhance accuracy in TRICARE East directories 2576 </h3> 2577 <div class="mi-article-cards__content-txt-eyebro-txt"> May 14, 2025</div> 2578 <p>
2578BetterDoctor® is a tool from Quest Analytics® that helps providers keep their directory information accurate with less effort. By checking your data, you make sure TRICARE East beneficiaries get timely and accurate information. This saves you time so you can focus more on caring for your patients.</p> 2579<p> </p> 2580<p><i>In the coming weeks, Humana Military network providers will receive a request via email, fax, direct mail and/or phone to verify their information every 90 days. Email requests will come from <a data-ispdf="false" data-iscta="false" href="mailto:validation@betterdoctor.com">validation@betterdoctor.com</a>.</i></p> 2581<p> </p> 2582<p>After verifying the first time, your information will automatically save, making ongoing verification a seamless process.</p> 2583<p> </p> 2584<p>Groups of 20+ providers, or five or more facility locations, will have the option of attesting by roster instead of updating providers individually in the BetterDoctor® portal, saving time and improving accuracy. More information regarding the roster option will be coming soon.</p> 2585 2586 </div> 2587 <div class="mi-article-cards__content-cta-wrap"> 2588 <div slot="cta"> 2589 2590 2591 2592 </div> 2593 </div> 2594</div></div> 2595<div class="richText text"> 2596<div data-cmp-data-layer="{"text-b5e882fbec":{"xdm:text":"&nbsp;&nbsp;","@type":"humana-military-com/components/richText","@id":"text-b5e882fbec","repo:modifyDate":"2024-04-09T16:51:04Z"}}" id="richText-b5e882fbec" class="cmp-text"> 2597 <p>  </p> 2598 2599</div> 2600 2601 2602 2603</div> 2604<div class="card"> 2605 2606 2607<div class="mi-article-cards__wrapper "> 2608 <div class="mi-article-cards__img-wrap"> 2609 <img/> 2610 </div> 2611 <div class="mi-article-cards__content-txt"> 2612 <h3 class="mi-article-cards__content-txt-title"> 2613 Q2 TRICARE reimbursement implementation update 2614 </h3> 2615 <div class="mi-article-cards__content-txt-eyebro-txt"> April 18, 2025</div> 2616 <p>Humana Military is actively processing claims while we are implementing the following quarterly reimbursement updates. During this process, claims status will be temporarily set to pending, and claims payments will resume once the implementation is complete.</p> 2617<p> </p> 2618<ul><li>Outpatient Prospective Payment System (OPPS)</li><li>
2618Ambulatory Surgery Center (ASC)</li><li>Applied Behavior Amounts (ABA)</li><li>Durable Medical Equipment, Prosthetics, Orthotics, and Supplies/Parenteral, Enteral Nutrition (DMEPOS/PEN)</li></ul> 2619 2620 </div> 2621 <div class="mi-article-cards__content-cta-wrap"> 2622 <div slot="cta"> 2623 2624 2625 2626 </div> 2627 </div> 2628</div></div> 2629<div class="richText text"> 2630<div data-cmp-data-layer="{"text-02c09c1efd":{"xdm:text":"&nbsp;&nbsp;","@type":"humana-military-com/components/richText","@id":"text-02c09c1efd","repo:modifyDate":"2024-04-09T16:51:04Z"}}" id="richText-02c09c1efd" class="cmp-text"> 2631 <p>Â Â </p> 2632 2633</div> 2634 2635 2636 2637</div> 2638<div class="card"> 2639 2640 2641<div class="mi-article-cards__wrapper "> 2642 <div class="mi-article-cards__img-wrap"> 2643 <img/> 2644 </div> 2645 <div class="mi-article-cards__content-txt"> 2646 <h3 class="mi-article-cards__content-txt-title"> 2647 Update on TRICARE claims payments 2648 </h3> 2649 <div class="mi-article-cards__content-txt-eyebro-txt"> April 17, 2025</div> 2650 <p>We want to inform you of a recently identified issue involving the incorrect processing of certain claims.</p> 2651<p>Â </p> 2652<p>Due to a system error, some network provider claims were incorrectly processed as if they were from non-network providers, causing incorrect payments.</p> 2653<p>Â </p> 2654<p>We are in the process of adjusting the impacted claims for proper payment. We appreciate your patience and understanding as we work through this as quickly as possible. Once claims have been corrected, updated Explanation of Benefits (EOB) and remittances will be sent.</p> 2655 2656 </div> 2657 <div class="mi-article-cards__content-cta-wrap"> 2658 <div slot="cta"> 2659 2660 2661 2662 </div> 2663 </div> 2664</div></div> 2665<div class="richText text"> 2666<div data-cmp-data-layer="{"text-3bc1bdb085":{"xdm:text":"&nbsp;&nbsp;","@type":"humana-military-com/components/richText","@id":"text-3bc1bdb085","repo:modifyDate":"2024-04-09T16:51:04Z"}}" id="richText-3bc1bdb085" class="cmp-text"> 2667 <p>Â Â </p> 2668 2669</div> 2670 2671 2672 2673</div> 2674<div class="card"> 2675 2676 2677<div class="mi-article-cards__wrapper "> 2678 <div class="mi-article-cards__img-wrap"> 2679 <img/> 2680 </div> 2681 <div class="mi-article-cards__content-txt"> 2682 <h3 class="mi-article-cards__content-txt-title"> 2683 TRICARE East Autism Care Demonstration (ACD) outcome measure completion 2684 </h3> 2685 <div class="mi-article-cards__content-txt-eyebro-txt"> February 4, 2025</div> 2686 <p>Humana Military has multiple options to administer the required outcome measures for ACD beneficiaries in the TRICARE East Region.</p> 2687<p>Â </p> 2688<p>We understand that due to state regulation and the scope of practice requirements, providers in Tennessee and North Carolina are prohibited from completing the Vineland Adaptive Behavior Scales, 3rd edition (Vineland-3), Social Responsiveness Scale, Second Edition (SRS-2), Parenting Stress Index, Fourth Edition, Short Form (PSI-4) and Stress Index for Parents of Adolescents (SIPA).</p> 2689<p>Â </p> 2690<p>However, we have other resources available to support the completion of these measures in a timely manner without impacting authorizations and delaying or preventing access to medically necessary Applied Behavior Analysis (ABA) and ongoing care. We have sufficient and eligible-contracted and credentialed providers to help implement the required outcome measures. These options align with TRICARE requirements as well as individual state regulations.</p> 2691<p>Â </p> 2692<p>We have the following processes in place to ensure continued measure completion: Â </p> 2693<ul><li>We will continue to leverage assigned Board Certified Behavior Analyst (BCBA) for measure completion when available and appropriate.</li><li>When the assigned BCBA isnât willing or able to complete measures, we will leverage our network of qualified BCBAs and psychologists to support measure completion.</li><li>When the BCBA isnât qualified to complete measures due to state regulations (including North Carolina and Tennessee), we will leverage our network of qualified psychologists, as well as psychologists embedded within our internal ACD program to supp
2693ort measure completion.</li><li>As part of our commitment and plan to ensure continuity of care and services for our ACD beneficiaries, as well as support for our ABA provider community, we have a direct email address for providers to submit specific concerns about outcome measures for individual beneficiaries.<ul><li>Beginning Monday, February 10, inquiries can be submitted to <a href="mailto:Humana_Military_ACD_OM_Requests@humanamilitary.com" data-ispdf="false" data-iscta="false">Humana_Military_ACD_OM_Requests@humanamilitary.com</a>. Our team of ACD professionals will review inquiries as they are received and facilitate the necessary support to ensure measures completion. Additionally, inquiries can always be submitted through <a href="https://infocenter.humana-military.com/prov/service/Account/Login" data-ispdf="false" data-iscta="false" target="_blank" rel="noopener noreferrer">provider self-service</a>.</li></ul> 2694</li></ul> 2695<p> </p> 2696<p>We appreciate your continued commitment to care for our beneficiaries and look forward to our ongoing partnership to support our TRICARE East population. </p> 2697 2698 </div> 2699 <div class="mi-article-cards__content-cta-wrap"> 2700 <div slot="cta"> 2701 2702 2703 2704 </div> 2705 </div> 2706</div></div> 2707<div class="richText text"> 2708<div data-cmp-data-layer="{"text-37cd02db76":{"xdm:text":"&nbsp;&nbsp;","@type":"humana-military-com/components/richText","@id":"text-37cd02db76","repo:modifyDate":"2024-04-09T16:51:04Z"}}" id="richText-37cd02db76" class="cmp-text"> 2709 <p>  </p> 2710 2711</div> 2712 2713 2714 2715</div> 2716<div class="card"> 2717 2718 2719<div class="mi-article-cards__wrapper "> 2720 <div class="mi-article-cards__img-wrap"> 2721 <img/> 2722 </div> 2723 <div class="mi-article-cards__content-txt"> 2724 <h3 class="mi-article-cards__content-txt-title"> 2725 Q1 TRICARE reimbursement implementation update 2726 </h3> 2727 <div class="mi-article-cards__content-txt-eyebro-txt"> February 3, 2025</div> 2728 <p>Humana Military is actively processing claims while we are implementing the following quarterly reimbursement updates. During this process, claims status will be temporarily set to pending, and claims payments will resume once the implementation is complete.</p> 2729<p> </p> 2730<ul><li>Outpatient Prospective Payment System (OPPS)</li><li>CMS Durable Medical Equipment Prosthetics, Orthotics and Supplies (DMEPOS)</li><li>CMS Durable Medical Equipment Parenteral and Enteral Nutrition (DMEPEN)</li><li>TRICARE DMEPOS</li><li>TRICARE Maximum Allowable Charge (CMAC) rates</li><li>Annual Diagnostic Related Grouping (DRG) file</li><li>Sole Community Hospital (SCH) cost-to-charge ratios</li><li>Ambulatory surgery center (ASC) rates</li><li>Banked Donor Milk (BDM) rates</li><li>Injectable rates</li><li>Breastfeeding Supplies (BFS) rates</li><li>Skilled Nursing Facility (SNF) payment system</li><li>Inpatient Rehab Facility (IRF) payment system</li><li>Long Term Care Hospital (LTCH) payment system</li></ul> 2731 2732 </div> 2733 <div class="mi-article-cards__content-cta-wrap"> 2734 <div slot="cta"> 2735 2736 2737 2738 </div> 2739 </div> 2740</div></div> 2741<div class="richText text"> 2742<div data-cmp-data-layer="{"text-e226f57a9b":{"xdm:text":"&nbsp;&nbsp;","@type":"humana-military-com/components/richText","@id":"text-e226f57a9b","repo:modifyDate":"2024-04-09T16:51:04Z"}}" id="richText-e226f57a9b" class="cmp-text"> 2743 <p>  </p> 2744 2745</div> 2746 2747 2748 2749</div> 2750<div class="card"> 2751 2752 2753<div class="mi-article-cards__wrapper "> 2754 <div class="mi-article-cards__img-wrap"> 2755 <img/> 2756 </div> 2757 <div class="mi-article-cards__content-txt"> 2758 <h3 class="mi-article-cards__content-txt-title"> 2759 Action Required: Applied Behavioral Analysis (ABA) Provider Agreement 2760 </h3> 2761 <div class="mi-article-cards__content-txt-eyebro-txt"> October 18, 2024</div> 2762 <p>TRICAREâs Autism Care Demonstration (ACD) program establishes provider requirements for those who provide Applied Behavior Analysis (ABA) services to TRICARE-eligible beneficiaries.</p> 2763<p> </p> 2764<p>The start of healthcare delivery under TRICAREâs new contracts begins on January 1, 2025.</p> 2765<p> </p> 2766<p>The Defense Health Agency (DHA) requires both Autism Care Demonstration Corporate Service Providers (ACSP) and sole providers to update their TRICARE participation agreements for the new contracts. <b>To remain TRICARE certified, all current network and non-network ACSP and sole providers are required to complete new participation agreements by December 1, 2024.</b> Providers that do not complete the new participation agreement will be terminated and no longer eligible to provide or receive reimbursement for ABA services beginning January 1, 2025.  </p> 2767<p> </p> 2768<p>Updated language regarding the Department of Defense ACD can be found in the <i>TRICARE Operations Manual (TOM), Ch. 18, Sec. 3, (formerly Ch. 18, Sec. 4</i>).</p> 2769<p> </p> 2770<p>Note: Individual behavior analysts, assistant behavior analysts and behavior technicians working under tiered delivery models do not need to complete the ACSP participation agreement.</p> 2771<p> </p> 2772<p>Please complete the attached <a></a><a data-ispdf="true" data-iscta="false" href="https://www.humanamilitary.com/content/dam/sites/humana-military-com/provider/ACSP-Participation-Agreement.pdf" target="_blank" rel="noopener noreferrer">participation agreement</a>
2772. The preferred method of return is by email at <a href="mailto:HMCertUpdates@HumanaMilitary.com" data-ispdf="false" data-iscta="false">HMCertUpdates@HumanaMilitary.com</a>. If you are unable to submit the agreement by email, you may return it by fax to (844) 684-7461.</p> 2773<p> </p> 2774<p>For questions about this notification, please contact us at <a data-ispdf="false" data-iscta="false" href="mailto:HMACDProviderInquiries@HumanaMilitary.com">HMACDProviderInquiries@HumanaMilitary.com</a>.</p> 2775 2776 </div> 2777 <div class="mi-article-cards__content-cta-wrap"> 2778 <div slot="cta"> 2779 2780 2781 2782 </div> 2783 </div> 2784</div></div> 2785<div class="richText text"> 2786<div data-cmp-data-layer="{"text-fcadfae811":{"xdm:text":"&nbsp;&nbsp;","@type":"humana-military-com/components/richText","@id":"text-fcadfae811","repo:modifyDate":"2024-04-09T16:51:04Z"}}" id="richText-fcadfae811" class="cmp-text"> 2787 <p>  </p> 2788 2789</div> 2790 2791 2792 2793</div> 2794<div class="card"> 2795 2796 2797<div class="mi-article-cards__wrapper "> 2798 <div class="mi-article-cards__img-wrap"> 2799 <img/> 2800 </div> 2801 <div class="mi-article-cards__content-txt"> 2802 <h3 class="mi-article-cards__content-txt-title"> 2803 Expansion of hearing aid coverage 2804 </h3> 2805 <div class="mi-article-cards__content-txt-eyebro-txt"> October 1, 2024</div> 2806 <p>Due to a recent TRICARE policy update, hearing aids and hearing aid services may be now covered for child dependents of former members of the Uniformed Services enrolled in TRICARE Prime with a profound hearing loss. Dependents of a member of the Uniformed Services on active duty includes all members covered under the Transitional Assistance Management Program (TAMP).</p> 2807<p> </p> 2808<p>This change is effective December 22, 2023. For more information, including exclusions to the coverage, visit <a href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2024-09-23/AsOf/TP15/C7S8_2.html" target="_blank" data-ispdf="false" data-iscta="false" rel="noopener noreferrer">TRICARE Policy Manual (TPM), Ch. 7, Sec. 8.2</a>. </p> 2809 2810 </div> 2811 <div class="mi-article-cards__content-cta-wrap"> 2812 <div slot="cta"> 2813 2814 2815 2816 </div> 2817 </div> 2818</div></div> 2819<div class="richText text"> 2820<div data-cmp-data-layer="{"text-097eddc67b":{"xdm:text":"&nbsp;&nbsp;","@type":"humana-military-com/components/richText","@id":"text-097eddc67b","repo:modifyDate":"2024-04-09T16:51:04Z"}}" id="richText-097eddc67b" class="cmp-text"> 2821 <p>  </p> 2822 2823</div> 2824 2825 2826 2827</div> 2828<div class="card"> 2829 2830 2831<div class="mi-article-cards__wrapper "> 2832 <div class="mi-article-cards__img-wrap"> 2833 <img/> 2834 </div> 2835 <div class="mi-article-cards__content-txt"> 2836 <h3 class="mi-article-cards__content-txt-title"> 2837 Official notice for providers transitioning to the West Region 2838 </h3> 2839 <div class="mi-article-cards__content-txt-eyebro-txt"> September 26, 2024</div> 2840 <p>Dear network provider:</p> 2841<p> </p> 2842<p>In your capacity as a provider who has partnered with Humana Military in the TRICARE East Region, we are pleased to share with you an important development affecting the care you provide to active duty service members, retirees and their families. Although no action on your part is required at this time, please read on for some important information.</p> 2843<p> </p> 2844<p>In December 2022, the Department of Defense announced that TriWest Healthcare Alliance (hereafter referred to as âTriWestâ) was selected as the regional contractor for the new West Region under the fifth generation TRICARE contract. The new West Region includes 26 states and will serve 4.3 million beneficiaries. Furthermore, Humana Military, currently the regional contractor for the East Region, has been re-awarded the East Region.</p> 2845<p> </p> 2846<p>Under the latest contract, six of the states currently in the East Region will transition to the new West Region effective January 1, 2025, and your state is one that will transition. As the executive leadership of TriWest and Humana Military, we are excited to announce that our companies have entered into an agreement to transition the provider contracts in the impacted geographies from Humana Military to TriWest. The effective date of the transition aligns with the start of healthcare delivery for the latest contract, which is January 1, 2025.</p> 2847<p> </p> 2848<p>This letter serves as an official notice that your Participating Provider Agreement will be assigned to TriWest<sup>1</sup> , with an effective date of assignment on January 1, 2025, when TriWest returns to TRICARE and becomes the regional contractor for the new West Region. From now through December 31, 2024, your current TRICARE provider status remains unchanged with Humana Military; therefore, continue to follow Humana Militaryâs procedures for dates of service through December 31, 2024.</p> 2849<p> </p> 2850<p>For groups or facilities that have providers and/or locations in both the East and West Regions: if 70 percent or more of their providers and facilities reside in the West Region as of January 1, 2025, they were included in the network sale to TriWest. Alternatively, if 30 percent or more will reside in the East Region on January 1, 2025 they remain the East Region to ensure benef
2850iciaries have adequate support and access.</p> 2851<p>Â </p> 2852<p>Your participation with TriWest is for dates of service starting on January 1, 2025, and after. Please be assured every step is being taken to complete this transition smoothly so that there will be no negative impact to you or your relationship with your TRICARE patients.</p> 2853<p>Â </p> 2854<p>You can start to prepare for the January 1, 2025, TriWest transition in the following ways:</p> 2855<p>Â </p> 2856<p><b>1. Register for a free account on <a href="https://www.availity.com/" target="_blank" data-ispdf="false" data-iscta="false" rel="noopener noreferrer">Availity.com</a></b></p> 2857<p>Availity is an online platform where you can manage multiple health plans you accept in one place. TriWest uses Availity as its secure provider portal. For TRICARE, TriWest will have a unique TRICARE Payer Space on Availity where you will be able to:</p> 2858<ul><li>Submit claims and check claims status</li><li>Access authorizations</li><li>Manage your demographic information (such as address and phone number)</li><li>Find tools and resources like the Provider Handbook, Quick Reference Guides and more</li><li>Take training on TRICARE processes and procedures</li></ul> 2859<p>Â </p> 2860<p>If you donât already have an account on Availity, register now: <a data-ispdf="false" data-iscta="false" href="https://www.availity.com/" target="_blank" rel="noopener noreferrer">Availity.com</a>.</p> 2861<p>Â </p> 2862<p>If you need help with registration or have questions about your Availity account, call Availity at 800-282-4548.</p> 2863<p>Â </p> 2864<p><b>2. Review the TriWest TRICARE West Region Provider Handbook</b><br /> 2865</p> 2866<p>The TriWest TRICARE West Region Provider Handbook contains information about program requirements, claims submission, eligibility, referrals and authorizations, and beneficiary out-of-pocket costs. You can find a link to the handbook on <a href="https://triwest.com/provider" target="_blank" data-ispdf="false" data-iscta="false" rel="noopener noreferrer">TriWest.com/Provider</a>.</p> 2867<p>Â </p> 2868<p>We thank you for your continued partnership in serving the healthcare needs of our nationâs military and its families, and we promise to continue to work together to ensure a smooth transition and keep you informed of pertinent information during this transition. If you have questions about your provider agreement for care delivered after January 1, 2025, please email TriWest Healthcare Alliance at <a data-ispdf="false" data-iscta="false" href="mailto:providerservices@triwest.com">providerservices@triwest.com</a>.</p> 2869<p>Â </p> 2870<p><i><span class="humanafont-regular-12px">*1 The Participating Provider Agreement will be assigned to TRICARE Region Providers, LLC, a Delaware limited liability company, which will transfer to ownership of TriWest effective on January 1, 2025</span></i></p> 2871 2872 </div> 2873 <div class="mi-article-cards__content-cta-wrap"> 2874 <div slot="cta"> 2875 2876 2877 2878 </div> 2879 </div> 2880</div></div> 2881<div class="richText text"> 2882<div data-cmp-data-layer="{"text-5e734e0964":{"xdm:text":"&nbsp;&nbsp;","@type":"humana-military-com/components/richText","@id":"text-5e734e0964","repo:modifyDate":"2024-04-09T16:51:04Z"}}" id="richText-5e734e0964" class="cmp-text"> 2883 <p>Â Â </p> 2884 2885</div> 2886 2887 2888 2889</div> 2890<div class="card"> 2891 2892 2893<div class="mi-article-cards__wrapper "> 2894 <div class="mi-article-cards__img-wrap"> 2895 <img/> 2896 </div> 2897 <div class="mi-article-cards__content-txt"> 2898 <h3 class="mi-article-cards__content-txt-title"> 2899 Update on coverage for platelet rich plasma injections 2900 </h3> 2901 <div class="mi-article-cards__content-txt-eyebro-txt"> September 26, 2024</div> 2902 <p>Effective October 1, 2024, TRICARE will no longer cover platelet rich plasma injections for any indication. The service was previously covered under Provisional Coverage for Emerging Services and Supplies for dates of service from Oct. 1, 2019, through September. 30, 2024. Â </p> 2903<p>Â </p> 2904<p>Please see the following manual links for more information about these changes:</p> 2905<p>Â </p> 2906<p><a href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2024-08-29/AsOf/TP15/C4S6_1.html" target="_blank" data-ispdf="false" data-iscta="false" rel="noopener noreferrer">TRICARE Policy Manual (TPM), Ch. 4, Sec. 6.1</a></p> 2907 2908 </div> 2909 <div class="mi-article-cards__content-cta-wrap"> 2910 <div slot="cta"> 2911 2912 2913 2914 </div> 2915 </div> 2916</div></div> 2917<div class="richText text"> 2918<div data-cmp-data-layer="{"text-d4de624b8e":{"xdm:text":"&nbsp;&nbsp;","@type":"humana-military-com/components/richText","@id":"text-d4de624b8e","repo:modifyDate":"2024-04-09T16:51:04Z"}}" id="richText-d4de624b8e" class="cmp-text"> 2919 <p>Â Â </p> 2920 2921</div> 2922 2923 2924 2925</div> 2926<div class="card"> 2927 2928 2929<div class="mi-article-cards__wrapper "> 2930 <div class="mi-article-cards__img-wrap"> 2931 <img/> 2932 </div> 2933 <div class="mi-article-cards__content-txt"> 2934 <h3 class="mi-article-cards__content-txt-title"> 2935 Red Hill fuel release public health response 2936 </h3> 2937 <div class="mi-article-cards__content-txt-eyebro-txt"> September 20, 2024</div> 2938 <p>In November 2021, there was a jet fuel spill in Oâahu, Hawaii that entered the water system of Joint Base Pearl Harbor-Hickam, known as the Red Hill fuel release. TRICARE beneficiaries exp
2938osed to the spill are eligible for medical assessments and, if deemed medically necessary, further care.</p> 2939<p> </p> 2940<p>Providers seeing TRICARE beneficiaries who were impacted by the spill and believe they have symptoms due to exposure can refer to <a data-ispdf="false" data-iscta="false" href="https://ph.health.mil/topics/campaigns/red-hill-public-health/Pages/default.aspx" target="_blank" rel="noopener noreferrer">DHAâs Red Hill fact sheet</a> for more details. Additional information for beneficiaries as they seek treatment is available at the <a data-ispdf="false" data-iscta="false" href="https://ph.health.mil/topics/campaigns/red-hill-public-health/Pages/default.aspx" target="_blank" rel="noopener noreferrer">Red Hill Public Health Information site</a>.</p> 2941<p> </p> 2942<p>Send questions, or report observations and insights to Defense Health Agency (DHA) Public Health via email at <a data-ispdf="false" data-iscta="false" href="mailto:dha.redhill@health.mil" target="_blank" rel="noopener noreferrer">dha.redhill@health.mil</a>.</p> 2943 2944 </div> 2945 <div class="mi-article-cards__content-cta-wrap"> 2946 <div slot="cta"> 2947 2948 2949 2950 </div> 2951 </div> 2952</div></div> 2953<div class="richText text"> 2954<div data-cmp-data-layer="{"text-6d89e9ddce":{"xdm:text":"&nbsp;&nbsp;","@type":"humana-military-com/components/richText","@id":"text-6d89e9ddce","repo:modifyDate":"2024-04-09T16:51:04Z"}}" id="richText-6d89e9ddce" class="cmp-text"> 2955 <p>  </p> 2956 2957</div> 2958 2959 2960 2961</div> 2962<div class="card"> 2963 2964 2965<div class="mi-article-cards__wrapper "> 2966 <div class="mi-article-cards__img-wrap"> 2967 <img/> 2968 </div> 2969 <div class="mi-article-cards__content-txt"> 2970 <h3 class="mi-article-cards__content-txt-title"> 2971 Reimbursement for services or items without established rates 2972 </h3> 2973 <div class="mi-article-cards__content-txt-eyebro-txt"> September 12, 2024</div> 2974 <p>TRICARE recently updated its policy to initiate payment thresholds for professional services, and Durable Medical Equipment, Prosthetics, Orthotics, and Supplies/Parenteral and Enteral Nutrition (DMEPOS/PEN) services without establishes rates. This policy provides guidelines for determining appropriate reimbursement for certain services prior to establishment of fee schedule rates to prevent reimbursement âsubstantially in excess of customary or reasonable charges.â </p> 2975<p> </p> 2976<p>Beginning on August 19, 2024, to align with this new policy, providers must submit the additional documentation with claims for dates of service on or after June 13, 2022. Per the new guidelines the following must be included with your claim submissions:</p> 2977<ul><li>Narrative description of the service or item;</li><li>A comparable procedure code;</li><li>The supplierâs price list amount for Durable Medical Equipment (DME) and supply codes (as applicable);</li><li>National Drug Code (NDC)#, dosage units and method of administration for drug codes (as applicable).</li></ul> 2978<p> </p> 2979<p>In addition, you may be asked to provide additional documentation or justification to support the use of procedure codes categorized as unlisted, miscellaneous, or not otherwise classified.</p> 2980<p> </p> 2981<p>Payment thresholds established under this guidance will only be used until a TRICARE fee schedule or state prevailing rate has been established. </p> 2982<p> </p> 2983<p>The policy only applies to either network or non-network providers. However, alternative network reimbursement methodologies are permitted when approved by the Defense Health Agency (DHA) and specifically included in the network provider agreement.</p> 2984<p> </p> 2985<p>For more information, visit <a href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2024-08-20/AsOf/TR15/C1ADE.html" target="_blank" data-ispdf="false" data-iscta="false" rel="noopener noreferrer">TRICARE Reimbursement Manual (TRM), Ch. 1, Addendum E</a>. </p> 2986 2987 </div> 2988 <div class="mi-article-cards__content-cta-wrap"> 2989 <div slot="cta"> 2990 2991 2992 2993 </div> 2994 </div> 2995</div></div> 2996<div class="richText text"> 2997<div data-cmp-data-layer="{"text-dff0092afe":{"xdm:text":"&nbsp;&nbsp;","@type":"humana-military-com/components/richText","@id":"text-dff0092afe","repo:modifyDate":"2024-04-09T16:51:04Z"}}" id="richText-dff0092afe" class="cmp-text"> 2998 <p>  </p> 2999 3000</div> 3001 3002 3003 3004</div> 3005<div class="card"> 3006 3007 3008<div class="mi-article-cards__wrapper "> 3009 <div class="mi-article-cards__img-wrap"> 3010 <img/> 3011 </div> 3012 <div class="mi-article-cards__content-txt"> 3013 <h3 class="mi-article-cards__content-txt-title"> 3014 Reminder of recertification requirements for certain facilities 3015 </h3> 3016 <div class="mi-article-cards__content-txt-eyebro-txt"> August 23, 2024</div> 3017 <p>TRICARE policy has recertification timelines included in participation agreements for certain provider classifications. Birthing centers, Residential Treatment Centers (RTC), and freestanding Parti
3017al Hospitalization Programs (PHP), Intensive Outpatient Programs (IOP), Opioid Treatment Programs (OTP), or inpatient/residential Substance Use Disorder Rehabilitation Facilities (SUDRF) are subject to the TRICARE recertification processes.</p> 3018<p>Â </p> 3019<p>To maintain eligibility as a TRICARE-authorized provider:</p> 3020<ul><li>Birthing centers must reapply every two years</li><li>RTC, freestanding PHP, IOP, OTP, and SUDRFs must reapply every five years</li></ul> 3021<p>Â </p> 3022<p>Prior to the expiration date of the participation agreement, Humana Military will mail notifications to providers that are due for recertification and must take action. The provider should gather the necessary certification information (current license and accreditation, for example) and visit <a data-ispdf="false" data-iscta="false" href="https://www.humanamilitary.com/provider/resources/tricarecertapps" target="_self" rel="noopener noreferrer">HumanaMilitary.com/certify</a> to submit the appropriate application.</p> 3023<p>Â </p> 3024<p>It is critical that the application is completed in a timely manner to avoid disruption. Failure to complete recertification may result in provider termination, claims denials or benef
3024iciary disruption of care.</p> 3025<p>Â </p> 3026<p>More information about provider certification requirements may be found in our FAQs <a data-ispdf="false" data-iscta="false" href="https://www.humanamilitary.com/provider/resources/tricarecertapps" target="_self" rel="noopener noreferrer">here</a>.</p> 3027<p>Â </p> 3028<p><i>*These requirements do not apply to SUD rehabilitation programs provided in units which are a distinct part of an authorized hospital, or to hospital-based IOP, OTP, or PHPs.</i></p> 3029 3030 </div> 3031 <div class="mi-article-cards__content-cta-wrap"> 3032 <div slot="cta"> 3033 3034 3035 3036 </div> 3037 </div> 3038</div></div> 3039<div class="richText text"> 3040<div data-cmp-data-layer="{"text-d9b9986918":{"xdm:text":"&nbsp;&nbsp;","@type":"humana-military-com/components/richText","@id":"text-d9b9986918","repo:modifyDate":"2024-04-09T16:51:04Z"}}" id="richText-d9b9986918" class="cmp-text"> 3041 <p>Â Â </p> 3042 3043</div> 3044 3045 3046 3047</div> 3048<div class="card"> 3049 3050 3051<div class="mi-article-cards__wrapper "> 3052 <div class="mi-article-cards__img-wrap"> 3053 <img/> 3054 </div> 3055 <div class="mi-article-cards__content-txt"> 3056 <h3 class="mi-article-cards__content-txt-title"> 3057 Update to TRICAREâs Childbirth and Breastfeeding Support Demonstration (CBSD) 3058 </h3> 3059 <div class="mi-article-cards__content-txt-eyebro-txt"> August 9, 2024 (Updated on August, 17, 2026)</div> 3060 <p><b>This demonstration has been extended through December 31, 2031.</b></p> 3061<p>The CBSD allows Certified Labor Doulas (CLD), lactation consultants or lactation counselors to provide care to eligible beneficiaries.</p> 3062<p>Â </p> 3063<p>TRICARE recently made changes to the CBSD to include the addition of the National Black Doulas Association (NBDA) as a certifying organization, participation in a Medicaid doula program as substitution for CLD certification, and a new requirement for CLDs to sign participation agreements to be eligible for TRICARE reimbursement.</p> 3064<p>Â </p> 3065<p><b>National Black Doulas Association (NBDA) accepted as CLD Certification Organization</b></p> 3066<p>Effective April 11, 2024, the NBDA is accepted as an additional certifying organization for CLDs. The CLD must hold a NBDA Birth Doula Certification to be considered eligible as a TRICARE-authorized provider.</p> 3067<p>Â </p> 3068<p><b>Medicaid participation for CLDs</b></p> 3069<p>Effective April 11, 2024, participation in a Medicaid doula program may be substituted for the national board certification requirement for CLDs practicing in states with an active statewide doula Medicaid benefit. Active Medicaid participation in lieu of national board certification will only be accepted for CLDs performing services in the same state in which they are a Medicaid doula. Participation must be in a permanent statewide Medicaid doula program, excluding geographically or time limited programs and programs with requirements set by affordable care or managed care organizations.</p> 3070<p>Â </p> 3071<p><b>Participation agreement requirements</b></p> 3072<p>To be eligible for reimbursement for dates of service on or after January 1, 2025, CLDs in the 50 US states and the District of Columbia must have a signed participation agreement on file. Participation agreements are effective the date signed and shall not be backdated to allow retroactive eligibility for reimbursement.</p> 3073<p>Â </p> 3074<p><a data-ispdf="true" data-iscta="false" href="https://www.humanamilitary.com/content/dam/sites/humana-military-com/provider/forms/provider_certifications/practitioner/certified-labor-d
3074oula-(CLD)-participation-agreement.pdf" target="_blank" rel="noopener noreferrer">Participation agreement</a></p> 3075<p>Â </p> 3076<p>Providers who complete participation agreements are not considered a network provider as the participation agreement is required for all TRICARE certified doulas. To become a network provider, you must have a contract with Humana Military.</p> 3077<p>Â </p> 3078<p><b>Childbirth Support Services Reimbursement - Phase 2<br /> 3079</b></p> 3080<p>The Childbirth Support Services Reimbursement Phase 1 will terminate at the end of the day on December 31, 2024. (See TRICARE Operations Manual (TOM) Ch. 18, Sec. 11, Para. 6.4 for more information). Childbirth support services reimbursement Phase 2 will be fully implemented by January 1, 2025, with a transition period starting June 10, 2024.</p> 3081<p>Here are some additional highlights about this change:</p> 3082<ul><li>During the transition period, providers that sign the participation agreement are eligible for Phase 2 reimbursement now through December 31, 2024.</li><li>The contractor shall reimburse a maximum of 24, 15-minute increments comb
3082ined for antepartum and postpartum visits per birth event.</li><li>The contractor shall reimburse the continuous labor support visit using CPT code T1033.</li><li>The contractor shall reimburse only one continuous labor support visit per birth event.</li><li>A participating CLD may bill under either Phase 1 or Phase 2 (i.e., use codes for either phase) during the transition period.</li><li>The contractor shall not reimburse a CLD for both Phase 1 and Phase 2 codes for the same date(s) of service.</li><li>The contractor shall not require a referral for childbirth support services except for a TRICARE Prime beneficiary receiving services from an out-of-network provider. If a TRICARE Prime beneficiary receives childbirth support services from an out-of-network CLD without a referral, Point of Service (POS) charges may apply.</li><li>The contractor shall not reimburse claims from a CLD for services not personally performed.</li><li>The contractor shall reimburse childbirth support services under Phase 2 using the reimbursement rates published to the DHA website.</li><li>The Defense Health Agency (DHA) will post the reimbursement rates to the DHA website by March 1 of each year, except for the CY 2024 rates, which will be published following publication of the federal register notice announcing the Phase 2 reimbursement methodology.</li><li>Antepartum and postpartum support visits are timed per 15-minute increment.</li><li>The contractor shall reimburse antepartum and postpartum support visits using CPT code T1032.</li></ul> 3083<p>Â </p> 3084<p>If you are already TRICARE certified as a CLD, in order to remain compliant with the new requirements of the demonstration, you will only need to complete the <a data-ispdf="false" data-iscta="false" href="https://www.humanamilitary.com/provider/resources/tricarecertapps" target="_self" rel="noopener noreferrer">Certified Labor Doula (CLD) - Participation Agreement Only</a>.<br /> 3085If you are not currently TRICARE certified as a CLD, please complete the entire <a data-ispdf="false" data-iscta="false" href="https://www.humanamilitary.com/provider/resources/tricarecertapps" target="_self" rel="noopener noreferrer">Certified Labor Doula â (CLD) application</a>.</p> 3086<p>Â </p> 3087<p><b>Please check back as new information becomes available about these changes.</b></p> 3088<p>Â </p> 3089<p>For more information on the CBSD, visit the <a data-ispdf="false" data-iscta="false" href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2024-06-10/AsOf/TO15/C18S11.html" target="_blank" rel="noopener noreferrer">TOM, Ch. 18, Sec. 11</a> and <a data-ispdf="false" data-iscta="false" href="https://www.humanamilitary.com/provider/resources/cbsd" target="_self" rel="noopener noreferrer">CBSD provider resources</a>.</p> 3090<p>Â </p> 3091<p>CLDs may access TRICARE certification applications <a data-ispdf="false" data-iscta="false" href="http://humanamilitary.com/provider/resources/tricarecertapps" target="_self" rel="noopener noreferrer">here</a>.</p> 3092 3093 </div> 3094 <div class="mi-article-cards__content-cta-wrap"> 3095 <div slot="cta"> 3096 3097 3098 3099 </div> 3100 </div> 3101</div></div> 3102<div class="richText text"> 3103<div data-cmp-data-layer="{"text-4abead15a0":{"xdm:text":"&nbsp;&nbsp;","@type":"humana-military-com/components/richText","@id":"text-4abead15a0","repo:modifyDate":"2024-04-09T16:51:04Z"}}" id="richText-4abead15a0" class="cmp-text"> 3104 <p>Â Â </p> 3105 3106</div> 3107 3108 3109 3110</div> 3111<div class="card"> 3112 3113 3114<div class="mi-article-cards__wrapper "> 3115 <div class="mi-article-cards__img-wrap"> 3116 <img/> 3117 </div> 3118 <div class="mi-article-cards__content-txt"> 3119 <h3 class="mi-article-cards__content-txt-title"> 3120 Expansion of extended benefits for Assisted Reproductive Technology (ART) 3121 </h3> 3122 <div class="mi-article-cards__content-txt-eyebro-txt"> July 5, 2024</div> 3123 <p>In March, TRICARE <a data-ispdf="false" data-iscta="false" href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2024-06-10/AsOf/TO15/C17S3.html" target="_blank" rel="noopener noreferrer">updated its policy</a> on Assisted Reproductive Technology (ART) for qualifying Active Duty Service Members (ADSM) with a Category II or III illness through the extended benefits authorized under 10 USC 1074(c)(4) under the Supplemental Health Care Program (SHCP). Now, in addition to the qualifying service member and their spouse, the following people may al
3123so receive ART services for the service memberâs benefit:</p> 3124<p>Â </p> 3125<ul><li>TRICARE-enrolled unmarried partners</li><li>TRICARE-enrolled third-party gestational carriers (if not being paid)</li></ul> 3126<p>Â </p> 3127<p>To obtain benefits for these parties, the referring provider must complete a <a data-ispdf="false" data-iscta="false" href="https://ias.csd.disa.mil/amserver/RUI/?realm=/pki&goto=https%3A%2F%2Fias.csd.disa.mil%2Famserver%2FWSFederationServlet%2FmetaAlias%2Fpki%2Flaunchpadaa-idp%3Fwa%3Dwsignin1.0%26wtrealm%3Dhttps%253a%252f%252finfo.health.mil%26wctx%3Dhttps%253a%252f%252finfo.health.mil%252fcos%252fadmin%252fDHA_Forms_Management%252f_layouts%252f15%252fAuthenticate.aspx%253fSource%253d%25252Fcos%25252Fadmin%25252FDHA%25255FForms%25255FManagement%25252FDHA%25255FForms1%25252FDHA%252520407%25252Epdf" target="_blank" rel="noopener noreferrer">DHA 407 form</a> into the Electronic Health Record (EHR) for the service member and the TRICARE-enrolled designee(s) and place a referral for the specific ART service being requested under the SHCP extended benefit.</p> 3128<p>Â </p> 3129<p>For more information, visit the <a data-ispdf="false" data-iscta="false" href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2024-06-10/AsOf/TO15/C17S3.html" target="_blank" rel="noopener noreferrer">TRICARE Operations Manual (TOM) Ch. 17, Sec. 3</a></p> 3130<p>Â </p> 3131<p>You can also read more at <a data-ispdf="false" data-iscta="false" href="https://newsroom.tricare.mil/News/TRICARE-News/Article/3803153/understand-how-tricare-covers-infertility-diagnosis-and-treatment" target="_blank" rel="noopener noreferrer">TRICARE.mil</a></p> 3132 3133 </div> 3134 <div class="mi-article-cards__content-cta-wrap"> 3135 <div slot="cta"> 3136 3137 3138 3139 </div> 3140 </div> 3141</div></div> 3142<div class="richText text"> 3143<div data-cmp-data-layer="{"text-6f42bfe99d":{"xdm:text":"&nbsp;&nbsp;","@type":"humana-military-com/components/richText","@id":"text-6f42bfe99d","repo:modifyDate":"2024-04-09T16:51:04Z"}}" id="richText-6f42bfe99d" class="cmp-text"> 3144 <p>Â Â </p> 3145 3146</div> 3147 3148 3149 3150</div> 3151 3152 3153 </div> 3154 3155</div> 3156<div class="container responsivegrid"> 3157 3158 3159 3160 3161 <div id="053124-SAC" class="cmp-container"> 3162 3163 <div class="card"> 3164 3165 3166<div class="mi-article-cards__wrapper "> 3167 <div class="mi-article-cards__img-wrap"> 3168 <img/> 3169 </div> 3170 <div class="mi-article-cards__content-txt"> 3171 <h3 class="mi-article-cards__content-txt-title"> 3172 Organ acquisition rates request update 3173 </h3> 3174 <div class="mi-article-cards__content-txt-eyebro-txt"> May 31, 2024</div> 3175 <p>Effective Oct. 28, 2019, TRICARE offers reimbursement for reasonable and necessary organ acquisition services and costs in support of quality organ transplant programs. Under Medicare, Certified Transplant Centers (CTC) and Organ Procurement Organizations (OPO) report these costs using the Centers for Medicare and Medicaid Services (CMS) Forms 2552 and 216. TRICARE will use the Medicare Standard Acquisition Charges (SAC) to determine reimbursement amounts.</p> 3176<p>Â </p> 3177<p>Humana Military is tasked each year with surveying all hospitals that had an organ acquisition cost and providing this information to the Defense Health Agency (DHA) for the TRICARE East Region.</p> 3178<p>Â </p> 3179<p>To remain compliant, providers should return the following documents before July 31, 2024:</p> 3180<ul><li>A completed <a data-ispdf="true" data-iscta="false" href="https://www.humanamilitary.com/content/dam/sites/humana-military-com/provider/forms/miscellaneous/standard-acquisition-charges-sac-for-organ-acquisition.pdf" target="_blank" rel="noopener noreferrer">Standard Acquisition Charges (SAC) for organ acquisition form</a></li><li>The most recent SAC rate reported to Medicare</li></ul> 3181<p>Â </p> 3182<p>Please use the form referenced above and do not submit D-4 worksheets.</p> 3183<p>Â </p> 3184<p>Please note: the address submitted on the form will be used for the annual correspondence for SAC rates.</p> 3185<p>Â </p> 3186<p>Failure to return this information will result in TRICAREâs use of a provider facilityâs overall operation cost-to-charge ratio to reduce charges, <a data-ispdf="false" data-iscta="false" href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2022-12-05/AsOf/TRT5/C1S40.html" target="_blank" rel="noopener noreferrer">per TRICARE Reimbursement Manual</a>. If a facility does not have any SAC rates for the year, providers should provide an explanation.</p> 3187<p>Â </p> 3188<p>Please return the required information, including any relevant point of contact to <a data-ispdf="false" data-iscta="false" href="mailto:HMHSPricingMailbox@humanaMilitary.com" target="_blank" rel="noopener noreferrer">HMHSPricingMailbox@HumanaMilitary.com</a></p> 3189<p>Â </p> 3190<p>For more information <a data-ispdf="true" data-iscta="false" href="https://www.humanamilitary.com/content/dam/sites/humana-military-com/provider/faqs/standard-acquisition-charges-sac-for-organ-acquisition.pdf" target="_blank" rel="noopener noreferrer">view FAQs</a>.</p> 3191 3192 </div> 3193 <div class="mi-article-cards__content-cta-wrap"> 3194 <div slot="cta"> 3195 3196 3197 3198 </div> 3199 </div> 3200</div></div> 3201 3202 3203 </div> 3204 3205</div> 3206<div class="container responsivegrid spacing-top-bottom--16px"> 3207 3208 3209 3210 3211 <div id="031324-NoPayList" class="cmp-container"> 3212 3213 <div class="richText text"> 3214<div data-cmp-data-layer="{"text-179d7ad148":{"xdm:text":"&nbsp;&nbsp;","@type":"humana-military-com/components/richText","@id":"text-179d7ad148","repo:modifyDate":"2024-04-09T16:51:04Z"}}" id="richText-179d7ad148" class="cmp-text"> 3215 <p>Â Â </p> 3216 3217</div> 3218 3219 3220 3221</div> 3222<div class="card"> 3223 3224 3225<div class="mi-article-cards__wrapper "> 3226 <div class="mi-article-cards__img-wrap"> 3227 <img/> 3228 </div> 3229 <div class="mi-article-cards__content-txt"> 3230 <h3 class="mi-article-cards__content-txt-title"> 3231 Reference numbers can now be created for basic inquiries through automated phone system 3232 </h3> 3233 <div class="mi-article-cards__content-txt-eyebro-txt"> May 17, 2024</div> 3234 <p>
3234Providers can now create reference numbers for basic inquiries on claim status, eligibility/benefits or referral/authorization status when using our automated phone system. To create a reference number, simply use your provider TIN + todays date in MM/DD/YYYY format.</p> 3235<p>Â </p> 3236<p>EXAMPLE: 78599632105172024</p> 3237 3238 </div> 3239 <div class="mi-article-cards__content-cta-wrap"> 3240 <div slot="cta"> 3241 3242 3243 3244 </div> 3245 </div> 3246</div></div> 3247<div class="richText text"> 3248<div data-cmp-data-layer="{"text-0bc56d07f2":{"xdm:text":"&nbsp;&nbsp;","@type":"humana-military-com/components/richText","@id":"text-0bc56d07f2","repo:modifyDate":"2024-04-09T16:51:04Z"}}" id="richText-0bc56d07f2" class="cmp-text"> 3249 <p>Â Â </p> 3250 3251</div> 3252 3253 3254 3255</div> 3256<div class="card"> 3257 3258 3259<div class="mi-article-cards__wrapper "> 3260 <div class="mi-article-cards__img-wrap"> 3261 <img/> 3262 </div> 3263 <div class="mi-article-cards__content-txt"> 3264 <h3 class="mi-article-cards__content-txt-title"> 3265 Changes to Freestanding Ambulatory Surgery Centers (ASC) reimbursement effective Oct. 1 3266 </h3> 3267 <div class="mi-article-cards__content-txt-eyebro-txt"> April 10, 2024</div> 3268 <p>Effective for service dates on or after October 1, 2023, TRICARE policy requires claims for care rendered at freestanding Ambulatory Surgery Centers (ASC) to process using the Medicare ASC Payment System for reimbursement. See the <a data-ispdf="false" data-iscta="false" href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2023-11-17/AsOf/TR15/C9S2.html#TR1517C0000F" target="_blank" rel="noopener noreferrer">TRICARE Reimbursement Manual (TRM) Ch. 9, Sec. 2 Ambulatory Surgical Center (ASC) Reimbursement for service on or after October 1, 2023</a>, for additional details.</p> 3269<p>Â </p> 3270<p>Freestanding ASCs that <b>specifically service pediatric populations</b>, and do not have a Medicare participation agreement, must be accredited by the Joint Commission or the Accreditation Association for Ambulatory Health Care (AAAHC) and enter into a participation agreement with TRICARE.</p> 3271<p>Â </p> 3272<p>Please see the following general guidance on claims reimbursement:</p> 3273<ul><li>Freestanding ASCs that <i>do not</i> meet all of the above Medicare eligibility requirements are no longer eligible for reimbursement for services rendered on or after October 1, 2023.</li><li>For services rendered before October 1, 2023, claims will be processed using the rates found on <a data-ispdf="false" data-iscta="false" href="https://www.cms.gov/medicare/payment/prospective-payment-systems/ambulatory-surgical-center-asc" target="_blank" rel="noopener noreferrer">Ambulatory Surgical Center (ASC) Payment</a> page.</li><li>Claims are now releasing in phases.</li></ul> 3274<p>Â </p> 3275<p>Additionally, per <a data-ispdf="false" data-iscta="false" href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2024-01-09/AsOf/TR15/C1S7.html" target="_blank" rel="noopener noreferrer">TRM Ch. 1, Sec 7</a>, facility claims should be filed on a UB-04.</p> 3276<p>Â </p> 3277<p>For more information about this TRICARE policy change, visit the <a data-ispdf="false" data-iscta="false" href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2023-11-17/AsOf/TR15/C9S2.html#TR1517C0000F" target="_blank" rel="noopener noreferrer">TRM, Ch. 9, Sec. 2</a></p> 3278<p>Â </p> 3279<p>For more information on participating with Medicare, providers should contact the <a data-ispdf="false" data-iscta="false" href="https://www.cms.gov/medicare/enrollment-renewal/providers-suppliers" target="_blank" rel="noopener noreferrer">Centers for Medicare & Medicaid Services (CMS)</a></p> 3280<p>Â </p> 3281<p>Please check back regularly as this article will be updated with the latest information.</p> 3282 3283 </div> 3284 <div class="mi-article-cards__content-cta-wrap"> 3285 <div slot="cta"> 3286 3287 3288 3289 </div> 3290 </div> 3291</div></div> 3292<div class="container responsivegrid"> 3293 3294 3295 3296 3297 <div id="container-2fa5a11306" class="cmp-container"> 3298 3299 <div class="richText text"> 3300<div data-cmp-data-layer="{"text-62966e33e8":{"xdm:text":"&nbsp;&nbsp;","@type":"humana-military-com/components/richText","@id":"text-62966e33e8","repo:modifyDate":"2024-04-09T16:51:04Z"}}" id="richText-62966e33e8" class="cmp-text"> 3301 <p>Â Â </p> 3302 3303</div> 3304 3305 3306 3307</div> 3308<div class="card"> 3309 3310 3311<div class="mi-article-cards__wrapper "> 3312 <div class="mi-article-cards__img-wrap"> 3313 <img/> 3314 </div> 3315 <div class="mi-article-cards__content-txt"> 3316 <h3 class="mi-article-cards__content-txt-title"> 3317 Update to Sensory Integration Therapy (SIT) billing 3318 </h3> 3319 <div class="mi-article-cards__content-txt-eyebro-txt"> April 10, 2024</div> 3320 <p>TRICARE recently clarified that SIT, billed as CPT code 97533, is not payable separately or when billed in conjunction with other therapies. For example, S
3320IT services provided during an otherwise covered multidisciplinary therapeutic intervention or service; during physical therapy, occupational therapy or speech therapy; or as a component of cognitive rehabilitation, are services for which TRICARE bundles payment in the payment for other related services.</p> 3321<p> </p> 3322<p>Additionally, CPT Code 97533 will be removed from the Government No Pay list and added to the bundled services list.</p> 3323<p> </p> 3324<p>The effective date for this change is April 26, 2024.</p> 3325<p> </p> 3326<p>For more information, see TRICARE Policy Manual (TPM) Ch. 7:</p> 3327<ul><li><a data-ispdf="false" data-iscta="false" href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2024-03-18/AsOf/TP15/C7S7_1.html" target="_blank" rel="noopener noreferrer">TPM Ch. 7, Sect. 7.1, Para. 4.7</a> (Speech Services)</li><li><a data-ispdf="false" data-iscta="false" href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2024-03-18/AsOf/TP15/C7S18_1.html" target="_blank" rel="noopener noreferrer">TPM Ch. 7, Sect. 18.1, Para. 3.5</a> (Rehabilitation â General)</li><li><a data-ispdf="false" data-iscta="false" href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2024-03-18/AsOf/TP15/C7S18_2.html" target="_blank" rel="noopener noreferrer">TPM Ch. 7, Sect. 18.2, Para. 4.11</a> (Physical Medicine/Therapy)</li><li><a data-ispdf="false" data-iscta="false" href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2024-03-18/AsOf/TP15/C7S18_3.html" target="_blank" rel="noopener noreferrer">TPM Ch. 7, Sect. 18.3, Para. 4.3</a> (Occupational Therapy)</li></ul> 3328 3329 </div> 3330 <div class="mi-article-cards__content-cta-wrap"> 3331 <div slot="cta"> 3332 3333 3334 3335 </div> 3336 </div> 3337</div></div> 3338<div class="richText text"> 3339<div data-cmp-data-layer="{"text-1e406f5ea3":{"xdm:text":"&nbsp;&nbsp;","@type":"humana-military-com/components/richText","@id":"text-1e406f5ea3","repo:modifyDate":"2024-04-09T19:59:44Z"}}" id="richText-1e406f5ea3" class="cmp-text"> 3340 <p>  </p> 3341 3342</div> 3343 3344 3345 3346</div> 3347 3348 3349 </div> 3350 3351</div> 3352<div class="card"> 3353 3354 3355<div class="mi-article-cards__wrapper "> 3356 <div class="mi-article-cards__img-wrap"> 3357 <img/> 3358 </div> 3359 <div class="mi-article-cards__content-txt"> 3360 <h3 class="mi-article-cards__content-txt-title"> 3361 Change Healthcare third party system outage 3362 </h3> 3363 <div class="mi-article-cards__content-txt-eyebro-txt"> March 26, 2024</div> 3364 <p>On February 21, 2024, Humana Military was alerted about a system outage affecting third-party vendor, Change Healthcare. Although Humana Military was not directly affected by this outage, many of our providers have reported issues. For urgent referral and authorization submissions that can't be processed through self-service, please contact us at (800) 444-5445. For routine requests, please allow two-business-day waiting period to check if service is restored before resorting to fax. Please note, due to contractual obligations, Humana Military is unable to suspend audits or waive referrals and authorizations at this time.</p> 3365<p> </p> 3366<p>Due to this outage, providers may choose from the following options to submit claims:</p> 3367<ol><li>Pick an alternate clearinghouse or vendor for electronic claims</li><li>Use <a href="https://infocenter.humana-military.com/prov/service/Account/Login" target="_blank" data-ispdf="false" data-iscta="false" rel="noopener noreferrer">self-service</a>, as long as the providerâs account is set up for electronic transactions</li><li>Submit paper claims, using either CMS1500 or UB04, depending on the type of the provider</li></ol> 3368 3369 </div> 3370 <div class="mi-article-cards__content-cta-wrap"> 3371 <div slot="cta"> 3372 3373 3374 3375 </div> 3376 </div> 3377</div></div> 3378 3379 3380 </div> 3381 3382</div> 3383<div class="container responsivegrid spacing-top-bottom--16px"> 3384 3385 3386 3387 3388 <div id="02162024-Spravato" class="cmp-container"> 3389 3390 <div class="card"> 3391 3392 3393<div class="mi-article-cards__wrapper "> 3394 <div class="mi-article-cards__img-wrap"> 3395 <img/> 3396 </div> 3397 <div class="mi-article-cards__content-txt"> 3398 <h3 class="mi-article-cards__content-txt-title"> 3399 Buy-and-Bill Reimbursement of Spravato 3400 </h3> 3401 <div class="mi-article-cards__content-txt-eyebro-txt"> February 16, 2024</div> 3402 <p>TRICARE recently updated language to clarify the billing procedures for the reimbursement of Spravato ® (esketamine) nasal spray.</p> 3403<p> </p> 3404<p>According to the Food and Drug Administration (FDA) labeling, Spravato is only to be distributed to certified pharmacies, healthcare providers and specialty distributors in the Risk Evaluation and Mitigation Strategy (REMS) program due to the risk of serious adverse outcomes. This requires <b>all </b>pharmacies to be REMS-certified and only dispense Spravato to health care settings certified in this program as well.</p> 3405<p> </p> 3406<p><b>Providers are no longer permitted to use âpharmacy billâ methodology for Spravato (HCPCS code S0013 and J3490). Instead, TRICARE only allows providers to buy-and-bill for the drug when rendering care, by utilizing G2082-83 code.</b></p> 3407<p> </p> 3408<p><a data-ispdf="false" href="https://www.spravatohcp.com/sites/www.spravatohcp-v1.com/files/pathway_to_acquire_spravato_through_asd_digital_final.pdf?v=14871" target="_blank" rel="noopener noreferrer">Learn more</a> about the REMS buy-and-bill application.</p> 3409 3410 </div> 3411 <div class="mi-article-cards__content-cta-wrap"> 3412 <div slot="cta"> 3413 3414 3415 3416 </div> 3417 </div> 3418</div></div> 3419 3420 3421 </div> 3422 3423</div> 3424<div class="container responsivegrid spacing-top-bottom--16px"> 3425 3426 3427 3428 3429 <div id="02162024-ACD" class="cmp-container"> 3430 3431 <div class="card"> 3432 3433 3434<div class="mi-article-cards__wrapper "> 3435 <div class="mi-article-cards__img-wrap"> 3436 <img/> 3437 </div> 3438 <div class="mi-article-cards__content-txt"> 3439 <h3 class="mi-article-cards__content-txt-title"> 3440 Autism Care Demonstration (ACD) update 3441 </h3> 3442 <div class="mi-article-cards__content-txt-eyebro-txt"> February 14, 2024</div> 3443 <p>Effective January 24, 2024, all<b> </b>Applied Behavior Analysis (ABA) outcome measures be completed no earlier than 90 days prior to their respective due date. Please be aware of all respective outcome measure due dates to prevent a delay in authorization of services. For more information, see <a href="http://manuals.health.mil/pages/DisplayManualHtmlFile/2023-12-22/AsOf/TO15/C18S4.html" target="_blank" data-ispdf="false" rel="noopener noreferrer">TRICARE Operations Manual (TOM) Ch. 18, Sec. 4, Para. 8.6.4.7.</a></p> 3444 3445 </div> 3446 <div class="mi-article-cards__content-cta-wrap"> 3447 <div slot="cta"> 3448 3449 3450 3451 </div> 3452 </div> 3453</div></div> 3454 3455 3456 </div> 3457 3458</div> 3459<div class="container responsivegrid spacing-top-bottom--16px"> 3460 3461 3462 3463 3464 <div id="02082024-CFLDT" class="cmp-container"> 3465 3466 <div class="card"> 3467 3468 3469<div class="mi-article-cards__wrapper "> 3470 <div class="mi-article-cards__img-wrap"> 3471 <img/> 3472 </div> 3473 <div class="mi-article-cards__content-txt"> 3474 <h3 class="mi-article-cards__content-txt-title"> 3475 Cystic Fibrosis (CF) coverage extended under the Laboratory Developed Tests (LDT) demonstration 3476 </h3> 3477 <div class="mi-article-cards__content-txt-eyebro-txt"> February 9, 2024</div> 3478 <p>TRICARE recently extended coverage for preconception and prenatal Cystic Fibrosis (CF) carrier screening, as well as the follow-on prenatal CF diagnostic genetic testing, such as amniocentesis, chorionic villus sampling, or chordocentesis, when provided in accordance with the most current American College of Obstetricians and Gynecologists (ACOG) guidelines.</p> 3479<p> </p> 3480<p>Additionally, this screening is exempt from the preauthorization requirements of this demonstration.</p> 3481<p> </p> 3482<p>Itâs important to note, that this change also updated the naming convention of these types of tests from âNon-FDA approved LDTsâ to âFDA Non-Approved LDTs.â</p> 3483<p> </p> 3484<p>For more information, please see <a href="http://manuals.health.mil/pages/DisplayManualHtmlFile/2024-01-12/AsOf/TO15/C18S3.html" target="_blank" rel="noopener noreferrer">TRICARE Operations Manual (TOM) Ch. 18, Sec. 3, Para 2.2, Change 133</a>.</p> 3485 3486 </div> 3487 <div class="mi-article-cards__content-cta-wrap"> 3488 <div slot="cta"> 3489 3490 3491 3492 </div> 3493 </div> 3494</div></div> 3495 3496 3497 </div> 3498 3499</div> 3500<div class="container responsivegrid spacing-top-bottom--16px"> 3501 3502 3503 3504 3505 <div id="01242024-ESRD" class="cmp-container"> 3506 3507 <div class="card"> 3508 3509 3510<div class="mi-article-cards__wrapper "> 3511 <div class="mi-article-cards__img-wrap"> 3512 <img/> 3513 </div> 3514 <div class="mi-article-cards__content-txt"> 3515 <h3 class="mi-article-cards__content-txt-title"> 3516 Billing update to End Stage Renal Disease (ESRD) facilities 3517 </h3> 3518 <div class="mi-article-cards__content-txt-eyebro-txt"> January 26, 2024</div> 3519 <p><b>Billing update to End Stage Renal Disease (ESRD) facilities</b></p> 3520<p>TRICARE no longer considers ESRD facilities (freestanding kidney dialysis centers) as Corporate Services Providers (CSP). These freestanding ESRD facilities are now recognized as authorized institutions for reimbursement and certification requirements and must meet the following criteria for reimbursement as listed in <a href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2023-12-20/AsOf/TP15/C11S2_10.html" target="_blank" rel="noopener noreferrer">TRICARE Policy Manual Chapter 11, Section 2.10</a>:</p> 3521<ul><li>Be classified as a freestanding ESRD facility by Medicare and be Medicare-certified</li><li>Be a TRICARE participating provider, and</li><li>Agree to accept the TRICARE payment as full payment for the care, services or supplies</li></ul> 3522<p> </p> 3523<p><b>Freestanding ESRD providers</b> that meet the above requirements will be authorized as TRICARE institutional providers. Providers who do not meet the criteria will no longer receive TRICARE reimbursement as a CSP for dates of services on or after January 12, 2023.</p> 3524<p> </p> 3525<p>This change aligns TRICARE with Medicare for reimbursement which includes a limitation of three dialysis sessions per week unless medical justification is provided and approved. Freestanding ESRD facilities should seek reimbursement for the facility/institutional component of dialysis sessions on a UB-04 claim form.</p> 3526<p> </p> 3527<p>See <a href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2023-11-17/AsOf/TR15/C18S1.html" target="_blank" rel="noopener noreferrer">TRICARE Reimbursement Manual (TRM), Ch. 18, Sec. 1</a> for more information on this change and its requirements.</p> 3528<p> </p> 3529<p>
3529Find out more about covered dialysis services in the <a href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2023-12-20/AsOf/TP15/C7S4_2.html" target="_blank" rel="noopener noreferrer">TPM, Ch. 7, Sec. 4.2.</a></p> 3530<p> </p> 3531<p>Find out more: <a href="https://www.cms.gov/medicare/payment/prospective-payment-systems/end-stage-renal-disease-esrd/esrd-pps-consolidated-billing" target="_blank" rel="noopener noreferrer">ESRD Prospective Payment System (PPS) consolidated billing</a></p> 3532<p> </p> 3533<p>View <a data-ispdf="true" href="https://www.humanamilitary.com/content/dam/sites/humana-military-com/government/esrd-faqs.pdf" target="_blank" data-iscta="false" rel="noopener noreferrer">ESRD FAQs</a></p> 3534 3535 </div> 3536 <div class="mi-article-cards__content-cta-wrap"> 3537 <div slot="cta"> 3538 3539 3540 3541 </div> 3542 </div> 3543</div></div> 3544 3545 3546 </div> 3547 3548</div> 3549<div class="container responsivegrid spacing-top-bottom--16px"> 3550 3551 3552 3553 3554 <div id="01242024-NTAP" class="cmp-container"> 3555 3556 <div class="card"> 3557 3558 3559<div class="mi-article-cards__wrapper "> 3560 <div class="mi-article-cards__img-wrap"> 3561 <img/> 3562 </div> 3563 <div class="mi-article-cards__content-txt"> 3564 <h3 class="mi-article-cards__content-txt-title"> 3565 New Technology Add-On Payment (NTAP) update 3566 </h3> 3567 <div class="mi-article-cards__content-txt-eyebro-txt"> January 26, 2024</div> 3568 <p>TRICARE has established criteria for pediatric NTAPs, as well as an approval process for a new technology to be considered for a TRICARE-designated NTAP. </p> 3569<p> </p> 3570<p><b>Pediatric-Specific NTAPs </b></p> 3571<p>Pediatric NTAP inpatient hospital claims may be applied when reimbursement is equal to the lesser of 100% of:</p> 3572<ul><li>the average cost of the technology, or</li><li>100 % of the total covered costs that exceeds the Medicare Severity-DRG payment.</li></ul> 3573<p>Pediatric-specific NTAPs apply to hospital discharges on or after July 1, 2022.</p> 3574<p>For more information, see <a href="http://manuals.health.mil/pages/DisplayManualHtmlFile/2024-01-09/AsOf/TR15/C6S11.html?highlight=tricare%20ntap%7C%7Cxfilter%28name%20%22C6S11.xml%22%29%20and%20xfilter%28word%20%22CHANGE_TYPE%3A%3AASOF%22%29%20and%20%28xfilter%28word%20%22ACRONYM%3A%3ATO15%22%20andword%20%22CHANGE_NO%3A%3A132%22%29%20or%20xfilter%28word%20%22ACRONYM%3A%3ATP15%22%20andword%20%22CHANGE_NO%3A%3A122%22%29%20or%20xfilter%28word%20%22ACRONYM%3A%3ATR15%22%20andword%20%22CHANGE_NO%3A%3A76%22%29%20or%20xfilter%28word%20%22ACRONYM%3A%3ATS15%22%20andword%20%22CHANGE_NO%3A%3A75%22%29%29%7C.html" target="_blank" rel="noopener noreferrer">TRICARE Reimbursement Manual (TRM), Ch. 6, Sec. 11, Para 4.3</a>.</p> 3575<p> </p> 3576<p><b>TRICARE-Designated NTAPs</b></p> 3577<p>Instances of TRICARE-covered services and supplies without a Medicare-established NTAP adjustment for Diagnosis Related Groups (DRG), may require DHA to designate a TRICARE NTAP adjustment. Technology manufacturers may request to be considered for a new TRICARE-designated NTAP by submitting <a href="https://www.humanamilitary.com/content/dam/sites/humana-military-com/provider/forms/claims/MRT-P00578-Pediatric-COVID-Policy-Application.pdf" target="_blank" data-ispdf="true" data-iscta="false" rel="noopener noreferrer">this application</a>.</p> 3578<p> </p> 3579<p>The deadline for receipt of application is <b>July 8</b> of the preceding fiscal year for the TRICARE NTAP to be considered.</p> 3580<p> </p> 3581<p>For more information, see <a href="http://manuals.health.mil/pages/DisplayManualHtmlFile/2024-01-09/AsOf/TR15/C6S11.html?highlight=tricare%20ntap%7C%7Cxfilter%28name%20%22C6S11.xml%22%29%20and%20xfilter%28word%20%22CHANGE_TYPE%3A%3AASOF%22%29%20and%20%28xfilter%28word%20%22ACRONYM%3A%3ATO15%22%20andword%20%22CHANGE_NO%3A%3A132%22%29%20or%20xfilter%28word%20%22ACRONYM%3A%3ATP15%22%20andword%20%22CHANGE_NO%3A%3A122%22%29%20or%20xfilter%28word%20%22ACRONYM%3A%3ATR15%22%20andword%20%22CHANGE_NO%3A%3A76%22%29%20or%20xfilter%28word%20%22ACRONYM%3A%3ATS15%22%20andword%20%22CHANGE_NO%3A%3A75%22%29%29%7C.html" target="_blank" rel="noopener noreferrer">TRM, Ch. 6, Sec. 11, Para 4.5.</a></p> 3582 3583 </div> 3584 <div class="mi-article-cards__content-cta-wrap"> 3585 <div slot="cta"> 3586 3587 3588 3589 </div> 3590 </div> 3591</div></div> 3592 3593 3594 </div> 3595 3596</div> 3597<div class="container responsivegrid spacing-top-bottom--16px"> 3598 3599 3600 3601 3602 <div id="01052024-TRICARESelect" class="cmp-container"> 3603 3604 <div class="card"> 3605 3606 3607<div class="mi-article-cards__wrapper "> 3608 <div class="mi-article-cards__img-wrap"> 3609 <img/> 3610 </div> 3611 <div class="mi-article-cards__content-txt"> 3612 <h3 class="mi-article-cards__content-txt-title"> 3613 Stay up to date on TRICARE Select 3614 </h3> 3615 <div class="mi-article-cards__content-txt-eyebro-txt"> January 5, 2024</div> 3616 <p>Did you know TRICARE beneficiaries may be enrolled in <a href="http://tricare.mil/Plans/HealthPlans/TS#content" target="_blank" rel="noopener noreferrer">TRICARE Select</a>? TRICARE Select is a self-managed, Preferred Provider Organization (PPO) plan available to eligible TRICARE beneficiaries who are non-active duty, not enrolled in TRICARE Prime.</p> 3617<p> </p> 3618<p>How it works:</p> 3619<ul><li>A provider must be TRICARE-authorized (any individual, institution/organization or supplier that is licensed by a state, accredited by n
3619ational organization, or meets other standards of the medical community, and is certified to provide benefits under TRICARE)</li><li>Referrals are not required for most primary and specialty appointments</li><li>Prior authorization may be required from Humana Military for some services</li></ul> 3620<p> </p> 3621<p>TRICARE Select beneficiaries do not have Primary Care Managers (PCM) and may self-refer to any TRICARE-authorized provider. However, certain services (e.g., inpatient admissions for substance abuse disorders and mental health, adjunctive dental care, home health services) require prior authorization from Humana Military.</p> 3622<p> </p> 3623<p>TRICARE Select is a great choice for your patients who:</p> 3624<ul><li>live in an area where they canât use TRICARE Prime</li><li>have Other Health Insurance (OHI)</li><li>are seeing a provider who isnât in the TRICARE network and donât want to switch</li></ul> 3625<p> </p> 3626<p>Eligible beneficiaries pay an annual outpatient deductible, cost-shares (or percentage) for covered services and Group A retirees must pay enrollment fees.</p> 3627<p> </p> 3628<p>Find out more about <a href="http://tricare.mil/Plans/HealthPlans/TS#content" target="_blank" rel="noopener noreferrer">TRICARE Select</a> and encourage beneficiaries to enroll today!</p> 3629 3630 </div> 3631 <div class="mi-article-cards__content-cta-wrap"> 3632 <div slot="cta"> 3633 3634 3635 3636 </div> 3637 </div> 3638</div></div> 3639 3640 3641 </div> 3642 3643</div> 3644<div class="container responsivegrid spacing-top-bottom--16px"> 3645 3646 3647 3648 3649 <div id="152024=ReimbursementHHA" class="cmp-container"> 3650 3651 <div class="card"> 3652 3653 3654<div class="mi-article-cards__wrapper "> 3655 <div class="mi-article-cards__img-wrap"> 3656 <img/> 3657 </div> 3658 <div class="mi-article-cards__content-txt"> 3659 <h3 class="mi-article-cards__content-txt-title"> 3660 Reimbursement changes for Home Health Agencies (HHA) 3661 </h3> 3662 <div class="mi-article-cards__content-txt-eyebro-txt"> January 5, 2024 update</div> 3663 <p>The Notice of Admission (NOA) was not adopted by the Defense Health Agency (DHA) so they are no longer required.</p> 3664<p> </p> 3665<p><a href="http://manuals.health.mil/pages/DisplayManualHtmlFile/2023-11-17/AsOf/TR15/C12S9.html" target="_blank" rel="noopener noreferrer">TRICARE Reimbursement Manual (TRM) Ch 12, Sec 9</a></p> 3666<p><a href="/content/dam/sites/humana-military-com/provider/faqs/HomeHealthAgency-reimbursement-faq.pdf" target="_blank" data-ispdf="true" data-iscta="false" rel="noopener noreferrer">Home Health Agency (HHA) reimbursement FAQs</a></p> 3667<p> </p> 3668<p><span class="humanafont-regular-12px"><b>February 6, 2023 update</b></span></p> 3669<p><b><span class="humanafont-regular-16px"> </span></b></p> 3670<p>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.<br /> 3671</p> 3672<p> </p> 3673<p>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.</p> 3674<p> </p> 3675<p><b>June 15, 2022 update</b></p> 3676<p> </p> 3677<p>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).</p> 3678<p> </p> 3679<p><b>March 4, 2022 update</b></p> 3680<p> </p> 3681<p>Humana Military is awaiting the Defense Health Agencyâs 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</p> 3682<p> </p> 3683<p>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.</p> 3684<p> </p> 3685<p>Retroactive to January 1, 2021, TRICARE has implemented the following changes.</p> 3686<p> </p> 3687<p><b>National Operating Standard Cost as a Share of Total Costs (NOSCASTC)</b></p> 3688<p> </p> 3689<p>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.  </p> 3690<p> </p> 3691<p><b>Split percentage payments and Requests for Anticipated Payment (RAP)</b></p> 3692<p> </p> 3693<p>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 âno payâ RAP at the beginning of care to establish the home health period of c
3693are, 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.  </p> 3694<p> </p> 3695<p><b>Low Utilization Payment Adjustment (LUPA)</b></p> 3696<p> </p> 3697<p>For periods of care beginning on or after January 1, 2020, if an HHA provides fewer than the threshold of visits specified for the periodâs 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.</p> 3698<p> </p> 3699<p>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.</p> 3700 3701 </div> 3702 <div class="mi-article-cards__content-cta-wrap"> 3703 <div slot="cta"> 3704 3705 3706 3707 </div> 3708 </div> 3709</div></div> 3710 3711 3712 </div> 3713 3714</div> 3715<div class="container responsivegrid spacing-top-bottom--32px"> 3716 3717 3718 3719 3720 <div id="12152023-StopFax" class="cmp-container"> 3721 3722 <div class="container responsivegrid"> 3723 3724 3725 3726 3727 <div id="container-5f6e65eb9c" class="cmp-container"> 3728 3729 <div class="card"> 3730 3731 3732<div class="mi-article-cards__wrapper "> 3733 <div class="mi-article-cards__img-wrap"> 3734 <img/> 3735 </div> 3736 <div class="mi-article-cards__content-txt"> 3737 <h3 class="mi-article-cards__content-txt-title"> 3738 eSHARE makes monthly provider roster submissions easier 3739 </h3> 3740 <div class="mi-article-cards__content-txt-eyebro-txt"> January 5, 2024</div> 3741 <p>Simplify the way you update provider data! The eSHARE electronic platform saves you time and reduces email. Using the provided template, monthly roster submissions are simpler than ever.</p> 3742<p>eShare helps providers and practices:</p> 3743<p> </p> 3744<ul><li>Control how your data appears in Humana Militaryâs system</li><li>Benefit from secure, simple and fast submissions</li><li>Have access 24/7 access</li><li>Submit your update when it is convenient for you</li><li>Receive instant confirmation of your acceptance</li><li>Receive instant alerts and instructions if additional information is needed</li></ul> 3745<p> </p> 3746<p>Roster changes are processed in less than 30 days.</p> 3747<p> </p> 3748<p>Contact your Humana Military TRICARE Community Liaison (TCL) to sign up and to learn more!</p> 3749 3750 </div> 3751 <div class="mi-article-cards__content-cta-wrap"> 3752 <div slot="cta"> 3753 3754 3755 3756 </div> 3757 </div> 3758</div></div> 3759<div class="container responsivegrid spacing-top-bottom--16px"> 3760 3761 3762 3763 3764 <div id="container-719fe3956e" class="cmp-container"> 3765 3766 <div class="card"> 3767 3768 3769<div class="mi-article-cards__wrapper "> 3770 <div class="mi-article-cards__img-wrap"> 3771 <img/> 3772 </div> 3773 <div class="mi-article-cards__content-txt"> 3774 <h3 class="mi-article-cards__content-txt-title"> 3775 Automatic Blood Pressure Monitors (BPM) coverage update 3776 </h3> 3777 <div class="mi-article-cards__content-txt-eyebro-txt"> December 22, 2023</div> 3778 <p>TRICARE has added coverage for automatic Blood Pressure Monitors (BPM), under <a href="http://manuals.health.mil/pages/DisplayManualHtmlFile/2023-12-20/AsOf/TP15/C8S2_1.html" target="_blank" rel="noopener noreferrer">TRICAREâs Durable Medical Equipment (DME) policy</a> (TRICARE Policy Manual (TPM), Chap.8, Sect. 2.1), for patients receiving covered Remote Physiologic Monitoring (RPM) services for medically necessary blood pressure monitoring.</p> 3779<p> </p> 3780<p><span class="humanafont-regular-16px">Exclusions to this coverage include:</span></p> 3781<p> </p> 3782<ul><li>Automatic blood pressure monitors that do not meet the TRICARE Programâs definition or coverage requirements for DME<br /> 3783</li><li>Automatic BPMs for patients not receiving covered RPM services for blood pressure monitoring</li><li>Manual blood pressure monitors</li></ul> 3784<p> </p> 3785<p>Reference <a href="http://manuals.health.mil/pages/DisplayManualHtmlFile/2023-12-20/AsOf/TP15/C8S2_1.html" target="_blank" rel="noopener noreferrer">TPM Chap. 8, Sect. 2.1</a> for more information about this change and RPM services.<br /> 3786</p> 3787 3788 </div> 3789 <div class="mi-article-cards__content-cta-wrap"> 3790 <div slot="cta"> 3791 3792 3793 3794 </div> 3795 </div> 3796</div></div> 3797 3798 3799 </div> 3800 3801</div> 3802<div class="container responsivegrid"> 3803 3804 3805 3806 3807 <div id="container-4dc1125b70" class="cmp-container"> 3808 3809 3810 3811 </div> 3812 3813</div> 3814<div class="container responsivegrid content-width spacing-top-bottom--32px"> 3815 3816 3817 3818 3819 <div id="20231220-BPM" class="cmp-container"> 3820 3821 <div class="card"> 3822 3823 3824<div class="mi-article-cards__wrapper "> 3825 <div class="mi-article-cards__img-wrap"> 3826 <img/> 3827 </div> 3828 <div class="mi-article-cards__content-txt"> 3829 <h3 class="mi-article-cards__content-txt-title"> 3830 Automatic Blood Pressure Monitors (BPM) coverage update 3831 </h3> 3832 <div class="mi-article-cards__content-txt-eyebro-txt"> December 22, 2023</div> 3833 <p>TRICARE has added coverage for automatic Blood Pressure Monitors (BPM), under <a href="http://manuals.health.mil/pages/DisplayManualHtmlFile/2023-12-20/AsOf/TP15/C8S2_1.html" target="_blank" rel="noopener noreferrer">TRICAREâs Durable Medical Equipment (DME) policy</a> (TRICARE Policy Manual (TPM), Chap.8, Sect. 2.1), for patients receiving covered Remote Physiologic Monitoring (RPM) services for medically necessary blood pressure monitoring.</p> 3834<p> </p> 3835<p><span class="humanafont-regular-16px">Exclusions to this coverage include:</span></p> 3836<p> </p> 3837<ul><li>Automatic blood pressure monitors that do not meet the TRICARE Programâs definition or coverage requirements for DME<br /> 3838</li><li>Automatic BPMs for patients not receiving covered RPM services for blood pressure monitoring</li><li>Manual blood pressure monitors</li></ul> 3839<p> </p> 3840<p>Reference <a href="http://manuals.health.mil/pages/DisplayManualHtmlFile/2023-12-20/AsOf/TP15/C8S2_1.html" target="_blank" rel="noopener noreferrer">TPM Chap. 8, Sect. 2.1</a> for more information about this change and RPM services.<br /> 3841</p> 3842 3843 </div> 3844 <div class="mi-article-cards__content-cta-wrap"> 3845 <div slot="cta"> 3846 3847 3848 3849 </div> 3850 </div> 3851</div></div> 3852<div class="container responsivegrid spacing-top-bottom--32px"> 3853 3854 3855 3856 3857 <div id="20211220-Ultrasound" class="cmp-container"> 3858 3859 <div class="card"> 3860 3861 3862<div class="mi-article-cards__wrapper "> 3863 <div class="mi-article-cards__img-wrap"> 3864 <img/> 3865 </div> 3866 <div class="mi-article-cards__content-txt"> 3867 <h3 class="mi-article-cards__content-txt-title"> 3868 Update to ultrasound surgery coverage details 3869 </h3> 3870 <div class="mi-article-cards__content-txt-eyebro-txt"> December 20, 2023</div> 3871 <p>Effective December 20, 2023, unilateral thalamotomy using Magnetic Resonance Image Guided Focused Ultrasound Surgery (MRgFUS) (CPT code 0398T) may be covered for the treatment of medication refractory essential tremor when:</p> 3872<ul><li>Provided with FDA-approved devices and</li><li>In accordance with the American Society for Stereotactic and Functional Neurosurgery coverage criteria</li></ul> 3873<p> </p> 3874<p>For more information, see TRICARE Policy Manual (TPM) Chap.4, Sect. 20.1, Para. 2.14. </p> 3875 3876 </div> 3877 <div class="mi-article-cards__content-cta-wrap"> 3878 <div slot="cta"> 3879 <a href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2023-12-20/AsOf/TP15/C4TOC.html" target="_blank">
3880 <button type="button" class="fnd-button nb-btn nb-btn--secondary"> 3881 See TPM Chap. 4 3882 </button> 3883 </a> 3884 3885 3886 </div> 3887 </div> 3888</div></div> 3889 3890 3891 </div> 3892 3893</div> 3894<div class="container responsivegrid spacing-top-bottom--32px"> 3895 3896 3897 3898 3899 <div id="12/19-RefAuth" class="cmp-container"> 3900 3901 <div class="card"> 3902 3903 3904<div class="mi-article-cards__wrapper "> 3905 <div class="mi-article-cards__img-wrap"> 3906 <img/> 3907 </div> 3908 <div class="mi-article-cards__content-txt"> 3909 <h3 class="mi-article-cards__content-txt-title"> 3910 Referrals and authorizations are going digital! 3911 </h3> 3912 <div class="mi-article-cards__content-txt-eyebro-txt"> December 18, 2023</div> 3913 <p>Humana Military is preparing to move all referrals and authorizations to electronic submissions, eliminating hard copy fax receipts. Instead, you can submit multiple documents for new and existing referrals/authorizations through <a href="https://infocenter.humana-military.com/prov/service/Account/Login" target="_blank" data-ispdf="false" data-iscta="false" rel="noopener noreferrer">provider self-service</a>. If you have not yet done so, please adjust your referral/authorization processes now to prepare for this upcoming change.</p> 3914<p> </p> 3915<p>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 <a href="https://www.surveymonkey.com/r/5T3VCJ2" target="_blank" title="New Window" rel="noopener noreferrer">fill out this survey</a> let us know how we can help you.</p> 3916<p> </p> 3917<p>If you need a self-service account to begin submitting online you can <a href="https://infocenter.humana-military.com/prov/service/Account/CreateAccount" target="_blank" data-ispdf="false" data-iscta="false" rel="noopener noreferrer">create one</a> today! For those providers who are already submitting referrals and authorizations through provider self-service- thank you!</p> 3918<p> </p> 3919<p>See <a href="/content/humana-military-com/us/en/provider/refsauths.html" target="_self" data-ispdf="false" data-iscta="false" rel="noopener noreferrer">referrals and authorizations</a> or <a href="https://www.brainshark.com/hgb/vu?pi=zHnzThKQmzRw6Vz0" data-ispdf="false" data-iscta="false">referral/authorization demonstration</a> or <a></a><a href="/content/dam/sites/humana-military-com/provider/faqs/provider-referral-policy-faq-XPAF1223-A.pdf" target="_blank" data-ispdf="false" data-iscta="false" rel="noopener noreferrer">FAQs</a>.</p> 3920 3921 </div> 3922 <div class="mi-article-cards__content-cta-wrap"> 3923 <div slot="cta"> 3924 3925 3926 3927 </div> 3928 </div> 3929</div></div> 3930 3931 3932 </div> 3933 3934</div> 3935<div class="container responsivegrid content-width spacing-top-bottom--32px"> 3936 3937 3938 3939 3940 <div id="container-9e8bf11d5e" class="cmp-container"> 3941 3942 <div class="card"> 3943 3944 3945<div class="mi-article-cards__wrapper "> 3946 <div class="mi-article-cards__img-wrap"> 3947 <img/> 3948 </div> 3949 <div class="mi-article-cards__content-txt"> 3950 <h3 class="mi-article-cards__content-txt-title"> 3951 Changes to Freestanding Ambulatory Surgery Centers (ASC) reimbursement effective Oct. 1 3952 </h3> 3953 <div class="mi-article-cards__content-txt-eyebro-txt"> December 18, 2023</div> 3954 <p>Effective for service dates on or after October 1, 2023, TRICARE policy requires claims for care rendered at freestanding Ambulatory Surgery Centers (ASC) to process using the Medicare ASC Payment System for reimbursement. See the <a href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2023-11-17/AsOf/TR15/C9S2.html#TR1517C0000F" target="_blank" rel="noopener noreferrer">TRICARE Reimbursement Manual (TRM) Ch. 9, Sec. 2 Ambulatory Surgical Center (ASC) Reimbursement for service on or after October 1, 2023</a>, for additional details. </p> 3955<p> </p> 3956<p>Freestanding ASCs that <b>specifically service pediatric populations,</b> and do not have a Medicare participation agreement, must be accredited by the Joint Commission or the Accreditation Association for Ambulatory Health Care (AAAHC) and enter into a participation agreement with TRICARE<i>.</i></p> 3957<p> </p> 3958<p>Please see the following general guidance on claims reimbursement:</p> 3959<ul><li>Freestanding ASCs that <i>do not</i> meet all of the above Medicare eligibility requirements are no longer eligible for reimbursement for services rendered on or after October 1, 2023.</li><li>For freestanding ASCs that meet the Medicare eligibility requirements, Humana Military will hold claims for their services rendered on or after October 1, 2023, until further guidance is received.  </li><li>For services rendered before October 1, 2023, claims will be processed using the rates found on <a href="https://www.cms.gov/medicare/payment/prospective-payment-systems/ambulatory-surgical-center-asc" target="_blank" data-ispdf="false" data-iscta="false" rel="noopener noreferrer">
3959Ambulatory Surgical Center (ASC) Payment page</a></li></ul> 3960<p> </p> 3961<p>For more information about this TRICARE policy change, visit the <a href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2023-11-17/AsOf/TR15/C9S2.html#TR1517C0000F" target="_blank" rel="noopener noreferrer">TRM, Ch. 9, Sec. 2</a></p> 3962<p> </p> 3963<p>For more information on participating with Medicare, providers should contact the <a href="https://www.cms.gov/medicare/enrollment-renewal/providers-suppliers" target="_blank" rel="noopener noreferrer">Centers for Medicare & Medicaid Services (CMS)</a></p> 3964<p> </p> 3965<p><b>Please check back regularly as this article will be updated with the latest information.</b></p> 3966 3967 </div> 3968 <div class="mi-article-cards__content-cta-wrap"> 3969 <div slot="cta"> 3970 3971 3972 3973 </div> 3974 </div> 3975</div></div> 3976 3977 3978 </div> 3979 3980</div> 3981<div class="card"> 3982 3983 3984<div class="mi-article-cards__wrapper "> 3985 <div class="mi-article-cards__img-wrap"> 3986 <img/> 3987 </div> 3988 <div class="mi-article-cards__content-txt"> 3989 <h3 class="mi-article-cards__content-txt-title"> 3990 Change to accessing basic referral information 3991 </h3> 3992 <div class="mi-article-cards__content-txt-eyebro-txt"> December 18, 2023</div> 3993 <p><b>As of December 18, 2023, Humana Military is no longer able to provide basic referral status information through the call center. To obtain this information, you must log in to your </b><a href="https://infocenter.humana-military.com/prov/service/Account/Login" target="_blank" data-ispdf="false" data-iscta="false" rel="noopener noreferrer">provider self-service account</a><b>, or call the automated</b> and interactive self-service phone line<b> at</b> (800) 444-5445<b>.</b></p> 3994<p> </p> 3995<p><b>Any referral issues or questions not related to basic referral details will be performed via the call center as normal. </b>Basic referral details includes details available in self-service like effective dates, number of visits, referral status, expiration dates and type of service.</p> 3996<p> </p> 3997<p><b>For more information on provider self-service account registration and accessing referral details, please visit </b>our <a href="https://www.humanamilitary.com/provider/resources/webinars" target="_self" rel="noopener noreferrer">on-demand webinar library</a> and view the tip sheet on <a href="https://www.humanamilitary.com/content/dam/sites/humana-military-com/provider/faqs/Provider-referral-authorization.pdf" target="_blank" data-ispdf="true" data-iscta="false" rel="noopener noreferrer">TRICARE referrals and prior authorizations</a>.</p> 3998 3999 </div> 4000 <div class="mi-article-cards__content-cta-wrap"> 4001 <div slot="cta"> 4002 4003 4004 4005 </div> 4006 </div> 4007</div></div> 4008 4009 4010 </div> 4011 4012</div> 4013<div class="container responsivegrid spacing-top-bottom--32px"> 4014 4015 4016 4017 4018 <div id="container-bb130af2fd" class="cmp-container"> 4019 4020 <div class="card"> 4021 4022 4023<div class="mi-article-cards__wrapper "> 4024 <div class="mi-article-cards__img-wrap"> 4025 <img/> 4026 </div> 4027 <div class="mi-article-cards__content-txt"> 4028 <h3 class="mi-article-cards__content-txt-title"> 4029 Coverage update to Mobile Medical Applications (MMA) 4030 </h3> 4031 <div class="mi-article-cards__content-txt-eyebro-txt"> December 1, 2023</div> 4032 <p>TRICARE recently clarified coverage criteria for Mobile Medical Applications (MMA) and related sensors based on existing TRICARE policy and regulations.</p> 4033<p> </p> 4034<p>Per TRICARE policy, there are currently no MMAs that meet TRICARE coverage criteria. Once an MMA meets all criteria, the relative paragraph will be updated in the TRICARE Policy Manual (TPM).</p> 4035<p> </p> 4036<p><a href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2023-11-28/AsOf/TP15/C1S1_2.html">TPM Ch 1, Sec 1.2, Para. 1.1.68</a> states âMobile Medical Applications (MMAs) and other digital therapeutics are excluded unless listed as covered by the TRICARE Program in <a href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2023-11-01/ChangeOnly/TP15/c8s2_1.html#BGBFAEJGJ8">TPM Ch. 8, Sec.2.1, Para. 3.12.5</a>.â</p> 4037 4038 </div> 4039 <div class="mi-article-cards__content-cta-wrap"> 4040 <div slot="cta"> 4041 4042 4043 4044 </div> 4045 </div> 4046</div></div> 4047 4048 4049 </div> 4050 4051</div> 4052<div class="container responsivegrid spacing-top-bottom--32px"> 4053 4054 4055 4056 4057 <div id="container-4a0137a89e" class="cmp-container"> 4058 4059 <div class="card"> 4060 4061 4062<div class="mi-article-cards__wrapper "> 4063 <div class="mi-article-cards__img-wrap"> 4064 <img/> 4065 </div> 4066 <div class="mi-article-cards__content-txt"> 4067 <h3 class="mi-article-cards__content-txt-title"> 4068 Rare diseases and fetal surgery coverage update 4069 </h3> 4070 <div class="mi-article-cards__content-txt-eyebro-txt"> October 20, 2023</div> 4071 <p>On November 13, 2023, TRICARE is adding coverage of fetoscopic and other minimally invasive surgery for the treatment of a rare disease, myelomeningocele (MMC). Cost-sharing may be considered when the gestational age of the fetus is 19.0 to 25.9 weeks and MMC is present with an upper boundary located between T1 through S1 with evidence of hindbrain herniation.</p> 4072<p> </p> 4073<p>For more information, see <a href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2023-09-25/AsOf/TP15/C1S3_1.html">TRICARE Policy Manual (TPM) Ch. 1, Sec 3.1, Para 2.31</a> and <a href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2023-09-25/AsOf/TP15/C4S18_5.html">TPM Ch. 4, Sec.18.5</a>.</p> 4074 4075 </div> 4076 <div class="mi-article-cards__content-cta-wrap"> 4077 <div slot="cta"> 4078 4079 4080 4081 </div> 4082 </div> 4083</div></div> 4084 4085 4086 </div> 4087 4088</div> 4089 4090 4091 </div> 4092 4093</div> 4094<div class="container responsivegrid spacing-top-bottom--32px"> 4095 4096 4097 4098 4099 <div id="container-bdb5a87cf0" class="cmp-container"> 4100 4101 <div class="card"> 4102 4103 4104<div class="mi-article-cards__wrapper "> 4105 <div class="mi-article-cards__img-wrap"> 4106 <img/> 4107 </div> 4108 <div class="mi-article-cards__content-txt"> 4109 <h3 class="mi-article-cards__content-txt-title"> 4110 Change to cancer and childrenâs hospital Outpatient Prospective Payment System (OPPS) reimbursement methodology 4111 </h3> 4112 <div class="mi-article-cards__content-txt-eyebro-txt"> October 19, 2023</div> 4113 <p>Effective for dates of service on or after October 1, 2023, cancer and childrenâs hospitals TRICARE maximum allowed reimbursement methodology for outpatient claims will begin to process using the Outpatient Prospective Payment System (OPPS) (<a href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2023-09-08/AsOf/TR15/C13TOC.html" target="_blank" rel="noopener noreferrer">TRICARE Reimbursement Manual (TRM), Ch. 13</a>, Sec. 1, Para. 3.4.1.1.5), and blended rates for radiology will end (TRM, Ch. 1, Sec. 24, Para. 2.9.7).</p> 4114<p> </p> 4115<p>For more information on the OPPS billing and reimbursement policy see Ch. 13. To learn more about the hold-harmless provision, see <a href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2023-09-08/AsOf/TR15/C13TOC.html" target="_blank" rel="noopener noreferrer">TRM Ch. 13, Sec. 3</a>, Para. 3.1.5.8.</p> 4116<p> </p> 4117<p>For more information about these changes to TRICARE reimbursement methodology, <a></a><a href="https://www.humanamilitary.com/content/dam/sites/humana-military-com/provider/faqs/Cancer%20and%20children%E2%80%99s%20hospital%20OPPS-FAQ.pdf" target="_blank" data-ispdf="true" data-iscta="false" rel="noopener noreferrer">visit our FAQs</a>.</p> 4118 4119 </div> 4120 <div class="mi-article-cards__content-cta-wrap"> 4121 <div slot="cta"> 4122 4123 4124 4125 </div> 4126 </div> 4127</div></div> 4128 4129 4130 </div> 4131 4132</div> 4133<div class="container responsivegrid"> 4134 4135 4136 4137 4138 <div id="container-29bae5fbc1" class="cmp-container"> 4139 4140 4141 4142 </div> 4143 4144</div> 4145<div class="card"> 4146 4147 4148<div class="mi-article-cards__wrapper "> 4149 <div class="mi-article-cards__img-wrap"> 4150 <img/> 4151 </div> 4152 <div class="mi-article-cards__content-txt"> 4153 <h3 class="mi-article-cards__content-txt-title"> 4154 Avoid improper billing practices 4155 </h3> 4156 <div class="mi-article-cards__content-txt-eyebro-txt"> September 1, 2023</div> 4157 <p>
4157Providers 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.</p> 4158<p> </p> 4159<p>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.</p> 4160<p> </p> 4161<p>Appending unwarranted modifiers to override the claims auditing software and allow additional payment for services that would normally be bundled is also considered fraudulent.</p> 4162<p> </p> 4163<p>Unbundling fraud in the TRICARE program results in unlawful reimbursement at the taxpayerâs 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.</p> 4164<p> </p> 4165<p>Examples of fraud:       </p> 4166<ul><li>Billing for costs of nonchargeable services, supplies or equipment disguised as covered items</li><li>Misrepresentations of description of services rendered</li></ul> 4167 4168 </div> 4169 <div class="mi-article-cards__content-cta-wrap"> 4170 <div slot="cta"> 4171 4172 4173 <a href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2023-04-04/AsOf/FR16/C9.html" target="_blank"> 4174 <button type="button" class="fnd-button nb-btn nb-btn--primary"> 4175 Find out more 4176 4177 <nucleus-icon class="is-after" name="new-window"/> 4178 4179 </button> 4180 </a> 4181 4182 </div> 4183 </div> 4184</div></div> 4185 4186 4187 </div> 4188 4189</div> 4190 4191 4192 </div> 4193 4194</div> 4195<div class="container responsivegrid content-width spacing-top-bottom--32px spacing-left-right--32px aem-GridColumn aem-GridColumn--default--12"> 4196 4197 4198 4199 4200 <div id="container-358ee1018f" class="cmp-container"> 4201 4202 <div class="card"> 4203 4204 4205<div class="mi-article-cards__wrapper "> 4206 <div class="mi-article-cards__img-wrap"> 4207 <img/> 4208 </div> 4209 <div class="mi-article-cards__content-txt"> 4210 <h3 class="mi-article-cards__content-txt-title"> 4211 Update to Laboratory Developed Test (LDT) demonstration 4212 </h3> 4213 <div class="mi-article-cards__content-txt-eyebro-txt"> August 18, 2023</div> 4214 <p><b>The Laboratory Developed Test (LDT) demonstration has been extended through July 18, 2028, and the following LDTs have been added:</b> </p> 4215<ul><li>Biotheranostics Breast Cancer Index</li><li>DermTech Pigmented Lesion Assay (PLSA)</li><li>FoundationOne Heme</li><li>MDxHealth Confirm MDx </li><li>MDxHealth Select MDx</li></ul> 4216<p> </p> 4217<p><b>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:</b></p> 4218<ul><li>confirmation of diagnosis in individuals showing clinical symptoms of CF or having a high sweat chloride level</li><li>identification of newborns who are affected with CF</li><li>identification of individuals with the p.Gly551Asp variant who will respond to treatment with ivacaftor</li><li>male infertility testing and treatment</li></ul> 4219<p> </p> 4220<p><a href="/content/humana-military-com/us/en/provider/refsauths.html">Learn more about LDTs</a></p> 4221<p> </p> 4222<p><a href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2023-07-28/AsOf/TO15/C18S3.html" target="_blank" rel="noopener noreferrer">TRICARE Manuals - Chap 18 Sect 3 (Change 125, Jul 28, 2023) (health.mil)</a>  </p> 4223 4224 </div> 4225 <div class="mi-article-cards__content-cta-wrap"> 4226 <div slot="cta"> 4227 4228 4229 4230 </div> 4231 </div> 4232</div></div> 4233 4234 4235 </div> 4236 4237</div> 4238<div class="container responsivegrid content-width spacing-top-bottom--32px spacing-left-right--32px aem-GridColumn aem-GridColumn--default--12"> 4239 4240 4241 4242 4243 <div id="container-1b455ac16f" class="cmp-container"> 4244 4245 <div class="card"> 4246 4247 4248<div class="mi-article-cards__wrapper "> 4249 <div class="mi-article-cards__img-wrap"> 4250 <img/> 4251 </div> 4252 <div class="mi-article-cards__content-txt"> 4253 <h3 class="mi-article-cards__content-txt-title"> 4254 Referrals and authorizations are going digital! 4255 </h3> 4256 <div class="mi-article-cards__content-txt-eyebro-txt"> August 22, 2023</div> 4257 <p>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 <a href="https://infocenter.humana-military.com/prov/service/Account/Login" target="_blank" data-ispdf="false" data-iscta="false" rel="noopener noreferrer">provider self-service</a>, you can submit multiple documents for new and existing referrals and authorizations.  </p> 4258<p> </p> 4259<p>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 <a href="https://www.surveymonkey.com/r/5T3VCJ2" target="_blank" rel="noopener noreferrer">this survey</a>
4259 to let us know how we can help you.</p> 4260<p> </p> 4261<p>If you need a self-service account to begin submitting online you can <a href="https://infocenter.humana-military.com/prov/service/Account/Login" target="_blank" data-ispdf="false" data-iscta="false" rel="noopener noreferrer">create one</a> today! For those providers who are already submitting referrals and authorizations through provider self-service- thank you!</p> 4262<p> </p> 4263<p>See <a href="https://www.humanamilitary.com/provider/refsauths" target="_self" rel="noopener noreferrer">referrals and authorizations</a> or <a href="https://www.humanamilitary.com/provider/resources/webinars" target="_self" rel="noopener noreferrer">referral/authorization demonstration</a> or <a href="https://www.humanamilitary.com/content/dam/sites/humana-military-com/provider/faqs/Provider-referral-authorization.pdf" target="_blank" data-ispdf="true" data-iscta="false" rel="noopener noreferrer">FAQs</a></p> 4264 4265 </div> 4266 <div class="mi-article-cards__content-cta-wrap"> 4267 <div slot="cta"> 4268 4269 4270 4271 </div> 4272 </div> 4273</div></div> 4274<div class="container responsivegrid spacing-top-bottom--32px"> 4275 4276 4277 4278 4279 <div id="230609eligibility" class="cmp-container" aria-label="New basic eligibility verification policy"> 4280 4281 <div class="card"> 4282 4283 4284<div class="mi-article-cards__wrapper "> 4285 <div class="mi-article-cards__img-wrap"> 4286 <img/> 4287 </div> 4288 <div class="mi-article-cards__content-txt"> 4289 <h3 class="mi-article-cards__content-txt-title"> 4290 New basic eligibility verification policy 4291 </h3> 4292 <div class="mi-article-cards__content-txt-eyebro-txt"> June 9, 2023</div> 4293 <p>Effective July 24, 2023, providers will no longer be able to obtain basic eligibility details from the call center and must use either <a href="https://infocenter.humana-military.com/prov/service/Account/Login?SecurityMessage=Invalid+or+expired+credentials.+&SecurityHttpCode=401&returnUrl=%2fprovider%2fservice%2f" target="_blank" data-ispdf="false" data-iscta="false" rel="noopener noreferrer">self-service</a> or call our automated system at (800) 444-5445.</p> 4294<p> </p> 4295<p>Basic eligibility details include benefit and coverage types, sponsor information, effective dates, copay and cost-share info, catastrophic cap, deductibles and Other Health Insurance (OHI) information can be found in self-service!</p> 4296<p> </p> 4297<p>Any eligibility issues or questions not related to basic eligibility verification will be performed via the call center as normal.</p> 4298<p> </p> 4299<p>For more information, check out the <a href="/content/dam/sites/humana-military-com/provider/faqs/provider-eligibility-faqs.pdf" target="_blank" data-ispdf="true" data-iscta="false" rel="noopener noreferrer">Provider Eligibility FAQs</a>.</p> 4300 4301 </div> 4302 <div class="mi-article-cards__content-cta-wrap"> 4303 <div slot="cta"> 4304 4305 4306 4307 </div> 4308 </div> 4309</div></div> 4310 4311 4312 </div> 4313 4314</div> 4315 4316 4317 </div> 4318 4319</div> 4320<div class="container responsivegrid content-width aem-GridColumn aem-GridColumn--default--12"> 4321 4322 4323 4324 4325 <div id="container-890ff2b6c5" class="cmp-container"> 4326 4327 <div class="columncontrol content-flex mi-article-item"> 4328 4329 <div class="cmp-section-content" style="background-color: ;"> 4330 <div class="aem-Grid aem-Grid--default--12 cmp-shell"> 4331 4332 4333 4334 <div class="container-column-control-parsys aem-GridColumn aem-GridColumn--default--12"> 4335 4336 4337 4338 4339 4340 4341 4342 <div class="container responsivegrid content-width spacing-top-bottom--32px"> 4343 4344 4345 4346 4347 <div id="container-7987ee2937" class="cmp-container"> 4348 4349 4350 4351 </div> 4352 4353</div> 4354 4355 4356 4357 </div> 4358 4359 </div> 4360 </div> 4361 4362 4363 4364 4365 4366
4367<script> 4368var width = window.outerWidth, 4369elements=document.querySelectorAll(".container-column-control-parsys"), 4370length=0, 4371mobileClassName=["aem-GridColumn aem-GridColumn--default--12"], 4372classname=["aem-GridColumn aem-GridColumn--default--6"]; 4373if(elements && mobileClassName && classname) { 4374 for (var i=0; i< elements.length; i++) { 4375 length = elements[i].closest(".container-column-control-parsys").length; 4376 if (width < 1200 && width > 767 && length != 3){ 4377 elements[i].classList.add(...classname); 4378 } 4379 else if (width < 768){ 4380 elements[i].classList.add(...mobileClassName); 4381 } 4382 } 4383} 4384</script>
4384</div> 4385 4386 4387 </div> 4388 4389</div> 4390<div class="container responsivegrid content-width spacing-top-bottom--32px aem-GridColumn aem-GridColumn--default--12"> 4391 4392 4393 4394 4395 <div id="container-188a82ab5a" class="cmp-container"> 4396 4397 <div class="card"> 4398 4399 4400<div class="mi-article-cards__wrapper "> 4401 <div class="mi-article-cards__img-wrap"> 4402 <img/> 4403 </div> 4404 <div class="mi-article-cards__content-txt"> 4405 <h3 class="mi-article-cards__content-txt-title"> 4406 Silicon Valley Bank (SVB)/ Signature Bank closures 4407 </h3> 4408 <div class="mi-article-cards__content-txt-eyebro-txt"> March 17, 2023</div> 4409 <p>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.</p> 4410<p><br /> 4411Earlier 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.</p> 4412<p><br /> 4413If 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 payerâs enrollment services.</p> 4414<p><br /> 4415We 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.</p> 4416 4417 </div> 4418 <div class="mi-article-cards__content-cta-wrap"> 4419 <div slot="cta"> 4420 4421 4422 4423 </div> 4424 </div> 4425</div></div> 4426 4427 4428 </div> 4429 4430</div> 4431<div class="container responsivegrid content-width spacing-top-bottom--32px aem-GridColumn aem-GridColumn--default--12"> 4432 4433 4434 4435 4436 <div id="container-77f8d3e05d" class="cmp-container"> 4437 4438 <div class="columncontrol content-flex mi-article-item"> 4439 4440 <div class="cmp-section-content" style="background-color: ;"> 4441 <div class="aem-Grid aem-Grid--default--12 cmp-shell"> 4442 4443 4444 4445 <div class="container-column-control-parsys aem-GridColumn aem-GridColumn--default--12"> 4446 4447 4448 4449 4450 4451 4452 4453 <div class="card"> 4454 4455 4456<div class="mi-article-cards__wrapper "> 4457 <div class="mi-article-cards__img-wrap"> 4458 <img/> 4459 </div> 4460 <div class="mi-article-cards__content-txt"> 4461 <h3 class="mi-article-cards__content-txt-title"> 4462 Access to Spravato® 4463 </h3> 4464 <div class="mi-article-cards__content-txt-eyebro-txt"> March 16, 2023</div> 4465 <p>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 FDAâs Risk Evaluation and Mitigation Strategy (REMS) program. This benefit is covered under the medical benefit, not pharmacy, and prior authorization is required.</p> 4466<p>While Walgreens is not a network provider at this time, prescriptions for Spravato (esketamine) can be filled through Walgreens Specialty Pharmacy.</p> 4467 4468 </div> 4469 <div class="mi-article-cards__content-cta-wrap"> 4470 <div slot="cta"> 4471 <a href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2022-12-30/AsOf/tp15/c7s3_8.html#FM62563" target="_blank">
4472 <button type="button" class="fnd-button nb-btn nb-btn--secondary"> 4473 TPM, Ch 7, Sec 3.8 4474 </button> 4475 </a> 4476 4477 <a href="https://www.humanamilitary.com/content/dam/sites/humana-military-com/provider/forms/claims/Spravato-Request-Form.pdf" target="_blank"> 4478 <button type="button" class="fnd-button nb-btn nb-btn--primary"> 4479 Spravato® intake form 4480 4481 <nucleus-icon class="is-after" name="new-window"/> 4482 4483 </button> 4484 </a> 4485 4486 </div> 4487 </div> 4488</div></div> 4489 4490 4491 4492 </div> 4493 4494 </div> 4495 </div> 4496 4497 4498 4499 4500 4501
4502<script> 4503var width = window.outerWidth, 4504elements=document.querySelectorAll(".container-column-control-parsys"), 4505length=0, 4506mobileClassName=["aem-GridColumn aem-GridColumn--default--12"], 4507classname=["aem-GridColumn aem-GridColumn--default--6"]; 4508if(elements && mobileClassName && classname) { 4509 for (var i=0; i< elements.length; i++) { 4510 length = elements[i].closest(".container-column-control-parsys").length; 4511 if (width < 1200 && width > 767 && length != 3){ 4512 elements[i].classList.add(...classname); 4513 } 4514 else if (width < 768){ 4515 elements[i].classList.add(...mobileClassName); 4516 } 4517 } 4518} 4519</script>
4519</div> 4520 4521 4522 </div> 4523 4524</div> 4525<div class="container responsivegrid content-width spacing-top-bottom--32px aem-GridColumn aem-GridColumn--default--12"> 4526 4527 4528 4529 4530 <div id="container-7b65237956" class="cmp-container"> 4531 4532 <div class="columncontrol content-flex"> 4533 4534 <div class="cmp-section-content" style="background-color: ;"> 4535 <div class="aem-Grid aem-Grid--default--12 cmp-shell"> 4536 4537 4538 4539 <div class="container-column-control-parsys aem-GridColumn aem-GridColumn--default--12"> 4540 4541 4542 4543 4544 4545 4546 4547 <div class="card"> 4548 4549 4550<div class="mi-article-cards__wrapper "> 4551 <div class="mi-article-cards__img-wrap"> 4552 <img/> 4553 </div> 4554 <div class="mi-article-cards__content-txt"> 4555 <h3 class="mi-article-cards__content-txt-title"> 4556 Reimbursement changes for Home Health Agencies (HHA) 4557 </h3> 4558 <div class="mi-article-cards__content-txt-eyebro-txt"> February 6, 2023 update</div> 4559 <p>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.</p> 4560<p>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.<br /> 4561Â </p> 4562<p><a href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2023-01-06/AsOf/TR15/C12S9.html" target="_blank" rel="noopener noreferrer">TRICARE Reimbursement Manual (TRM) Ch 12, Sec 9</a></p> 4563<p><a href="https://www.humanamilitary.com/content/dam/sites/humana-military-com/provider/faqs/HomeHealthAgency-reimbursement-faq.pdf" target="_blank" data-ispdf="true" data-iscta="false" rel="noopener noreferrer">Home Health Agency (HHA) reimbursement FAQs</a><br /> 4564Â </p> 4565<p><b>June 15, 2022<br /> 4566 Â </b></p> 4567<p>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).</p> 4568<p><b><br /> 4569March 4, 2022 - Update<br /> 4570 Â </b></p> 4571<p>Humana Military is awaiting the Defense Health Agencyâs 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</p> 4572<p>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.</p> 4573<p>Retroactive to January 1, 2021, TRICARE has implemented the following changes.</p> 4574<p><b><br /> 4575National Operating Standard Cost as a Share of Total Costs (NOSCASTC)<br /> 4576 Â </b></p> 4577<p>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.</p> 4578<p><b><br /> 4579Split percentage payments and Requests for Anticipated Payment (RAP)<br /> 4580 Â </b></p> 4581<p>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 âno payâ 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.</p> 4582<p><b><br /> 4583Low Utilization Payment Adjustment (LUPA)<br /> 4584 Â </b></p> 4585<p>For periods of care beginning on or after January 1, 2020, if an HHA provides fewer than the threshold of visits specified for the peri
4585odâs 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.</p> 4586<p>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.</p> 4587 4588 </div> 4589 <div class="mi-article-cards__content-cta-wrap"> 4590 <div slot="cta"> 4591 4592 4593 4594 </div> 4595 </div> 4596</div></div> 4597 4598 4599 4600 </div> 4601 4602 </div> 4603 </div> 4604 4605 4606 4607 4608 4609
4610<script> 4611var width = window.outerWidth, 4612elements=document.querySelectorAll(".container-column-control-parsys"), 4613length=0, 4614mobileClassName=["aem-GridColumn aem-GridColumn--default--12"], 4615classname=["aem-GridColumn aem-GridColumn--default--6"]; 4616if(elements && mobileClassName && classname) { 4617 for (var i=0; i< elements.length; i++) { 4618 length = elements[i].closest(".container-column-control-parsys").length; 4619 if (width < 1200 && width > 767 && length != 3){ 4620 elements[i].classList.add(...classname); 4621 } 4622 else if (width < 768){ 4623 elements[i].classList.add(...mobileClassName); 4624 } 4625 } 4626} 4627</script>
4627</div> 4628 4629 4630 </div> 4631 4632</div> 4633<div class="container responsivegrid content-width spacing-bottom--56px aem-GridColumn aem-GridColumn--default--12"> 4634 4635 4636 4637 4638 <div id="container-6460322feb" class="cmp-container"> 4639 4640 <div class="columncontrol content-flex"> 4641 4642 <div class="cmp-section-content" style="background-color: ;"> 4643 <div class="aem-Grid aem-Grid--default--12 cmp-shell"> 4644 4645 4646 4647 <div class="container-column-control-parsys aem-GridColumn aem-GridColumn--default--12"> 4648 4649 4650 4651 4652 4653 4654 </div> 4655 4656 </div> 4657 </div> 4658 4659 4660 4661 4662 4663
4664<script> 4665var width = window.outerWidth, 4666elements=document.querySelectorAll(".container-column-control-parsys"), 4667length=0, 4668mobileClassName=["aem-GridColumn aem-GridColumn--default--12"], 4669classname=["aem-GridColumn aem-GridColumn--default--6"]; 4670if(elements && mobileClassName && classname) { 4671 for (var i=0; i< elements.length; i++) { 4672 length = elements[i].closest(".container-column-control-parsys").length; 4673 if (width < 1200 && width > 767 && length != 3){ 4674 elements[i].classList.add(...classname); 4675 } 4676 else if (width < 768){ 4677 elements[i].classList.add(...mobileClassName); 4678 } 4679 } 4680} 4681</script>
4681</div> 4682 4683 4684 </div> 4685 4686</div> 4687<div class="container responsivegrid content-width spacing-top-bottom--32px aem-GridColumn aem-GridColumn--default--12"> 4688 4689 4690 4691 4692 <div id="container-2b8e97dc41" class="cmp-container"> 4693 4694 <div class="card"> 4695 4696 4697<div class="mi-article-cards__wrapper "> 4698 <div class="mi-article-cards__img-wrap"> 4699 <img/> 4700 </div> 4701 <div class="mi-article-cards__content-txt"> 4702 <h3 class="mi-article-cards__content-txt-title"> 4703 Update to TRICARE's Childbirth and Breastfeeding Support Demonstration (CBSD) 4704 </h3> 4705 <div class="mi-article-cards__content-txt-eyebro-txt"> August 24, 2023</div> 4706 <p>TRICAREâs Childbirth and Breastfeeding Support Demonstration allows Certified Labor Doulas (CLD), lactation consultants or lactation counselors to provide care to eligible beneficiaries.</p> 4707<p> </p> 4708<p>Effective July 25, the following virtual health services for the CBSD are no longer included:</p> 4709<ul><li>Audio-only breastfeeding counseling</li><li>Antepartum and postpartum care visits</li></ul> 4710<p> </p> 4711<p><b>Please note: All childbirth support services provided by a Certified Labor Doula (CLD) must be in-person.</b></p> 4712<p> </p> 4713<p>As a reminder, providers must use a two-way visual component to provide breastfeeding support services via virtual health.</p> 4714<p> </p> 4715<p>To verify you are able to continue to provide these services, please review <a href="https://www.humanamilitary.com/provider/resources/telemedicine" target="_self" rel="noopener noreferrer">Virtual health for providers</a>.</p> 4716<p> </p> 4717<p>For more information on the CBSD, visit <a href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2023-07-28/AsOf/TO15/C18S11.html">TRICARE Operations Manual</a> and <a href="https://www.humanamilitary.com/provider/resources/cbsd">CBSD provider resources</a>.</p> 4718 4719 </div> 4720 <div class="mi-article-cards__content-cta-wrap"> 4721 <div slot="cta"> 4722 4723 4724 4725 </div> 4726 </div> 4727</div></div> 4728 4729 4730 </div> 4731 4732</div> 4733<div class="container responsivegrid content-width spacing-top-bottom--32px aem-GridColumn aem-GridColumn--default--12"> 4734 4735 4736 4737 4738 <div id="container-1de0a469ee" class="cmp-container"> 4739 4740 <div class="card"> 4741 4742 4743<div class="mi-article-cards__wrapper "> 4744 <div class="mi-article-cards__img-wrap"> 4745 <img/> 4746 </div> 4747 <div class="mi-article-cards__content-txt"> 4748 <h3 class="mi-article-cards__content-txt-title"> 4749 Get the latest on the COVID-19 Public Health Emergency ending 4750 </h3> 4751 <div class="mi-article-cards__content-txt-eyebro-txt"> May 16, 2023</div> 4752 <p>The COVID-19 Public Health Emergency (PHE) expired on May 11, 2023 along with TRICAREâs temporary coverage and payment for certain services. As a result, key impacts due to the expiration of the PHE include (but are not limited to):</p> 4753<p><b>Relaxation of state professional licensing requirements</b></p> 4754<p>The temporary relaxation of state professional licensing requirements has expired.</p> 4755<p> </p> 4756<p><b>TRICARE coverage of acute care facilities and temporary expansion of hospital sites, including Medicareâs Hospitals Without Walls (HWW) initiative</b></p> 4757<p>Coverage of temporary hospitals, freestanding Ambulatory Surgical Centers (ASC), and other entities enrolled with Medicare as hospitals expires upon the expiration of Medicareâs HWW initiative.</p> 4758<p>Claims for dates of services through the PHE expiration date will continue to process under the temporary classification.</p> 4759<p>Organizations previously considered a TRICARE-authorized, freestanding ASC may return to that classification, provided all federal and state licensure/certification requirements are current.</p> 4760<p>If your organization wishes to participate in TRICARE as a hospital and has been certified as such by Centers for Medicare & Medicaid Services (CMS) or The Joint Commission (TJC), please visit <a href="https://www.humanamilitary.com/provider/resources/tricarecertapps" target="_self" data-ispdf="false" data-iscta="false" rel="noopener noreferrer">HumanaMilitary.com/certify</a> to submit a hospital application.</p> 4761<p> </p> 4762<p><b>Certain Critical Access Hospital (CAH) participation requirements</b></p> 4763<p>The requirements that CAHs provide 24-hour emergency care services and no more than 25 beds for acute, hospital-level inpatient care, or swing beds for Skilled Nursing Facility-Level care, and maintain a length-of-stay of no more than 96 hours, determined annually, expire.</p> 4764<p>You can visit <a href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2023-04-27/AsOf/TP15/C1S15_1.html">TRICARE Coverage and Payment for Certain Services in Response to the Coronavirus Disease 2019 (COVID-19) Pandemic</a> for complete details on each amendment to TRICARE policy.</p> 4765<p> </p> 4766<p><b>Skilled Nursing Facilities (SNF) three-day prior hospital stay requirement waiver</b></p> 4767<p>The waiver for a qualifying hospital stay of three consecutive days or more, not including hospital discharge day, prior to SNF admission, expired on April 10, 2023 with the Presidentâs termination of the national emergency.</p> 4768<p>You can visit <a href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2023-05-03/AsOf/TR15/C1S42.html" target="_blank" rel="noopener noreferrer">Temporary Reimbursement Changes In Response To The Coronavirus Disease 2019 (COVID-19) Pandemic</a> for complete details.</p> 4769 4770 </div> 4771 <div class="mi-article-cards__content-cta-wrap"> 4772 <div slot="cta"> 4773 4774 4775 4776 </div> 4777 </div> 4778</div></div> 4779 4780 4781 </div> 4782 4783</div> 4784<div class="container responsivegrid content-width spacing-top-bottom--32px aem-GridColumn aem-GridColumn--default--12"> 4785 4786 4787 4788 4789 <div id="container-a27ac2309f" class="cmp-container"> 4790 4791 <div class="card"> 4792 4793 4794<div class="mi-article-cards__wrapper "> 4795 <div class="mi-article-cards__img-wrap"> 4796 <img/> 4797 </div> 4798 <div class="mi-article-cards__content-txt"> 4799 <h3 class="mi-article-cards__content-txt-title"> 4800 Increase to number of milk bags covered every 30 days 4801 </h3> 4802 <div class="mi-article-cards__content-txt-eyebro-txt"> May 10, 2023</div> 4803 <p>Starting on May 3, 2023, TRICARE now allows a refill of 100 breast milk supply bags every 30 days following a birth event. This is an increase from 90 bags.</p> 4804<p> </p> 4805<p><a href="https://tricare.mil/CoveredServices/IsItCovered/BreastPumpsSupplies" target="_blank" rel="noopener noreferrer">Learn more</a></p> 4806 4807 </div> 4808 <div class="mi-article-cards__content-cta-wrap"> 4809 <div slot="cta"> 4810 4811 4812 4813 </div> 4814 </div> 4815</div></div> 4816 4817 4818 </div> 4819 4820</div> 4821<div class="container responsivegrid content-width spacing-top-bottom--32px aem-GridColumn aem-GridColumn--default--12"> 4822 4823 4824 4825 4826 <div id="container-578b1ecbbf" class="cmp-container"> 4827 4828 <div class="card"> 4829 4830 4831<div class="mi-article-cards__wrapper "> 4832 <div class="mi-article-cards__img-wrap"> 4833 <img/> 4834 </div> 4835 <div class="mi-article-cards__content-txt"> 4836 <h3 class="mi-article-cards__content-txt-title">
4837 Clarification on Partial Hospitalization Programs (PHP) claims and codes 4838 </h3> 4839 <div class="mi-article-cards__content-txt-eyebro-txt"> June 21, 2023</div> 4840 <p>When billing Partial Hospitalization Program (PHP) services, revenue codes 0913 or 0912 should be filed with the correct Healthcare Common Procedure Coding System (HCPC) code to allow the system to calculate the appropriate allowed amounts to ensure proper payment.</p> 4841<p> </p> 4842<p><b>Note:</b> Revenue codes must be billed separately for each date of service.</p> 4843<p> </p> 4844<p>Partial Hospitalization Program (PHP) and Intensive Outpatient Program (IOP) claims are to be submitted per policy as listed below:</p> 4845<p> </p> 4846<p><b>Non-Outpatient Prospective Payment System (OPPS) payable providers</b></p> 4847<ul><li>Revenue code 0912 can be billed with HCPCS H0035 or by itself for half-day service</li><li>Revenue code 0913 can be billed with HCPCS H0037 or by itself for full-day service</li><li>Revenue code 0905 or 0906 can be billed with H0015 or S9480</li></ul> 4848<p> </p> 4849<p><b>OPPS payable providers</b></p> 4850<ul><li>Revenue codes 0914 and 0915 are payable only to OPPS providers. Please reference figure 13.2.1 for the listing of OPPS payable HCPCS codes referenced in the TRICARE Reimbursement Manual provided below</li><li>Revenue code 0905 or 0906 can be billed with H0015 or S9480</li><li>All claims must be billed with condition code 41 on CMS 1450 UB-04 Claim Form</li></ul> 4851<p> </p> 4852<p>For guidance, please see <a href="https://manuals.health.mil/pages/DisplayManual.aspx?SeriesId=REIMBRSMT">TRICARE Reimbursement Manual, Chapter 13, Section 2</a>.</p> 4853<p> </p> 4854<p><b>A note on claims corrections</b></p> 4855<p>Claims corrections will occur on all PHP and IOP providers whose claims were incorrectly paid due to this issue.</p> 4856<p> </p> 4857<p>Providers will have the option to correct either the HCPCS code or revenue code. To correct the spreadsheet, add the correct code to the column which best represents the service provided. After reviewing all claims on the spreadsheet and updating the column appropriately. This will serve as documentation to make corrections to the claims. Send the file to the email or mailing address below.</p> 4858<p> </p> 4859<p>Recoupment action will be initiated 60 days after the date of this notice for all claims that were overpaid if no action is received from the provider. The provider can submit a corrected claim.</p> 4860<p> </p> 4861<p><b>Email</b></p> 4862<p><a href="mailto:TRICAREEastProviderInquiry@humana.com">TRICAREEastProviderInquiry@humana.com</a></p> 4863<p> </p> 4864<p><b>Mail</b></p> 4865<p>TRICARE East Region claims</p> 4866<p>Attn: Corrected claims</p> 4867<p>PO Box 8904</p> 4868<p>Madison, WI 53708-8904</p> 4869<p> </p> 4870<p><b>Fax</b></p> 4871<p>(608) 327-8523</p> 4872 4873 </div> 4874 <div class="mi-article-cards__content-cta-wrap"> 4875 <div slot="cta"> 4876 4877 4878 4879 </div> 4880 </div> 4881</div></div> 4882 4883 4884 </div> 4885 4886</div> 4887<div class="container responsivegrid content-width spacing-top-bottom--32px aem-GridColumn aem-GridColumn--default--12"> 4888 4889 4890 4891 4892 <div id="container-68778a6a50" class="cmp-container"> 4893 4894 <div class="card"> 4895 4896 4897<div class="mi-article-cards__wrapper "> 4898 <div class="mi-article-cards__img-wrap"> 4899 <img/> 4900 </div> 4901 <div class="mi-article-cards__content-txt"> 4902 <h3 class="mi-article-cards__content-txt-title"> 4903 Submit your certification applications digitally 4904 </h3> 4905 <div class="mi-article-cards__content-txt-eyebro-txt"> September 1, 2023</div> 4906 <p>*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.</p> 4907<p> </p> 4908<p>Please dispose of any paper applications or PDFs you have on hand, and instead access our most current, digital versions at <a href="https://www.humanamilitary.com/provider/resources/tricarecertapps" target="_self" rel="noopener noreferrer">HumanaMilitary.com/certify</a>.</p> 4909<p> </p> 4910<p>What are the benefits of digital certification applications?</p> 4911<ul><li>Faster processing time</li><li>Instant electronic confirmation of receipt</li><li><a href="https://infocenter.humana-military.com/HGBProvider/ProviderCertificationStatusPortal" target="_blank" rel="noopener noreferrer">Check applicaiton status online</a></li><li>Improved submission accuracy</li><li>Real-time feedback</li><li>Captures all necessary attachments</li><li>Prevents submission of incomplete applications</li><li>Less touchpointsâno need to call or email to confirm receipt or follow-up</li></ul> 4912<p> </p> 4913<p>Thank you for your cooperation as continue to work to enhance the certification application process.</p> 4914<p> </p> 4915<p><i>*After October 1, the only remaining print certification applications will be Virtual Health Only applications.  </i></p> 4916 4917 </div> 4918 <div class="mi-article-cards__content-cta-wrap"> 4919 <div slot="cta"> 4920 4921 4922 4923 </div> 4924 </div> 4925</div></div> 4926 4927 4928 </div> 4929 4930</div> 4931<div class="container responsivegrid content-width spacing-top-bottom--32px aem-GridColumn aem-GridColumn--default--12"> 4932 4933 4934 4935 4936 <div id="container-398c1fb252" class="cmp-container"> 4937 4938 <div class="card"> 4939 4940 4941<div class="mi-article-cards__wrapper "> 4942 <div class="mi-article-cards__img-wrap"> 4943 <img/> 4944 </div> 4945 <div class="mi-article-cards__content-txt"> 4946 <h3 class="mi-article-cards__content-txt-title"> 4947 Abortion billing tips 4948 </h3> 4949 <div class="mi-article-cards__content-txt-eyebro-txt"> November 30, 2022</div> 4950 <p>
4950To receive correct reimbursement, please ensure all required information is included, per <a href="https://manuals.health.mil" target="_blank" rel="noopener noreferrer">TRICARE Policy Manual (TPM)</a> Chapter 4 Section 18.3.</p> 4951<p><b><br /> 4952Claims must be submitted with the following:<br /> 4953  </b></p> 4954<p>G7 modifier, which is defined as the pregnancy resulted from rape or incest, or pregnancy certified by physician as life threatening</p> 4955<p>One of the condition codes listed below: </p> 4956<p>AA - Abortion performed due to rape;</p> 4957<p>AB - Abortion performed due to incest;</p> 4958<p>AD - Abortion performed due to life endangering physical condition</p> 4959<p>For more information, visit <a href="https://tricare.mil" target="_blank" rel="noopener noreferrer">TRICARE.mil</a>.</p> 4960 4961 </div> 4962 <div class="mi-article-cards__content-cta-wrap"> 4963 <div slot="cta"> 4964 4965 4966 4967 </div> 4968 </div> 4969</div></div> 4970 4971 4972 </div> 4973 4974</div> 4975<div class="container responsivegrid content-width spacing-top-bottom--32px aem-GridColumn aem-GridColumn--default--12"> 4976 4977 4978 4979 4980 <div id="container-b742025a7d" class="cmp-container"> 4981 4982 <div class="card"> 4983 4984 4985<div class="mi-article-cards__wrapper "> 4986 <div class="mi-article-cards__img-wrap"> 4987 <img/> 4988 </div> 4989 <div class="mi-article-cards__content-txt"> 4990 <h3 class="mi-article-cards__content-txt-title"> 4991 Provider 2020 - 2021 Archival Articles 4992 </h3> 4993 <div class="mi-article-cards__content-txt-eyebro-txt"> Archive 2020 - 2021</div> 4994 <p><b>Updated Autism Care Demonstration (ACD) concurrent billing information</b><br /> 4995</p> 4996<p>December 13, 2021</p> 4997<p>Per TRICARE policy, concurrent billing is not permitted. Only one code should be billed when concurrent care services are performed. If both are billed concurrently TRICARE will pay the higher charge and deny the lesser. If the lesser charge is received first, TRICARE will pro-rate the higher charge.</p> 4998<p>Note: When billing any session, please remember to enter the appropriate units rendered for the applicable procedure code.</p> 4999<p>For additional guidance see the <a href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2022-12-30/AsOf/TO15/C18S3.html">TRICARE Operations Manual, Chapter 18, section 3, 8.11.7.3.8</a></p> 5000<p>Concurrent billing is excluded for all ACD Category I CPT codes except when the family and the beneficiary are receiving separate services and the beneficiary is not present in the family session. Documentation must indicate two separate rendering providers and locations for the services.</p> 5001<p>· The contractor shall pay the higher rate and deny the other if CPT codes 97153 and 97155 are billed concurrently.</p> 5002<table border="1"><tbody><tr><td><p> </p> 5003<p> </p> 5004<p>CPT CODES</p> 5005<p> </p> 5006<p> </p> 5007</td><td><p> </p> 5008<p> </p> 5009<p>97151</p> 5010<p> </p> 5011<p> </p> 5012</td><td><p> </p> 5013<p> </p> 5014<p>97153</p> 5015<p> </p> 5016<p> </p> 5017</td><td><p> </p> 5018<p> </p> 5019<p>97155</p> 5020<p> </p> 5021<p> </p> 5022</td><td><p> </p> 5023<p> </p> 5024<p>97156</p> 5025<p> </p> 5026<p> </p> 5027</td><td><p> </p> 5028<p> </p> 5029<p>97157</p> 5030<p> </p> 5031<p> </p> 5032</td><td><p> </p> 5033<p> </p> 5034<p>97158</p> 5035<p> </p> 5036<p> </p> 5037</td></tr><tr><td><p> </p> 5038<p> </p> 5039<p>97151</p> 5040<p> </p> 5041<p> </p> 5042</td><td><p> </p> 5043<p> </p> 5044<p>N/A</p> 5045<p> </p> 5046<p> </p> 5047</td><td><p> </p> 5048<p> </p> 5049<p> </p> 5050<p> </p> 5051<p> </p> 5052</td><td><p> </p> 5053<p> </p> 5054<p> </p> 5055<p> </p> 5056<p> </p> 5057</td><td><p> </p> 5058<p> </p> 5059<p> </p> 5060<p> </p> 5061<p> </p> 5062</td><td><p> </p> 5063<p> </p> 5064<p> </p> 5065<p> </p> 5066<p> </p> 5067</td><td><p> </p> 5068<p> </p> 5069<p> </p> 5070<p> </p> 5071<p> </p> 5072</td></tr><tr><td><p> </p> 5073<p> </p> 5074<p>97153</p> 5075<p> </p> 5076<p> </p> 5077</td><td><p> </p> 5078<p> </p> 5079<p>Y</p> 5080<p> </p> 5081<p> </p> 5082</td><td><p> </p> 5083<p> </p> 5084<p>N/A</p> 5085<p> </p> 5086<p> </p> 5087</td><td><p> </p> 5088<p> </p> 5089<p> </p> 5090<p> </p> 5091<p> </p> 5092</td><td><p> </p> 5093<p> </p> 5094<p> </p> 5095<p> </p> 5096<p> </p> 5097</td><td><p> </p> 5098<p> </p> 5099<p> </p> 5100<p> </p> 5101<p> </p> 5102</td><td><p> </p> 5103<p> </p> 5104<p> </p> 5105<p> </p> 5106<p> </p> 5107</td></tr><tr><td><p> </p> 5108<p> </p> 5109<p>97155</p> 5110<p> </p> 5111<p> </p> 5112</td><td><p> </p> 5113<p> </p> 5114<p>N</p> 5115<p> </p> 5116<p> </p> 5117</td><td><p> </p> 5118<p> </p> 5119<p>N</p> 5120<p> </p> 5121<p> </p> 5122</td><td><p> </p> 5123<p> </p> 5124<p>N/A</p> 5125<p> </p> 5126<p> </p> 5127</td><td><p> </p> 5128<p> </p> 5129<p> </p> 5130<p> </p> 5131<p> </p> 5132</td><td><p> </p> 5133<p> </p> 5134<p> </p> 5135<p> </p> 5136<p> </p> 5137</td><td><p> </p> 5138<p> </p> 5139<p> </p> 5140<p> </p> 5141<p> </p> 5142</td></tr><tr><td><p> </p> 5143<p> </p> 5144<p>97156</p> 5145<p> </p> 5146<p> </p> 5147</td><td><p> </p> 5148<p> </p> 5149<p>Y</p> 5150<p> </p> 5151<p> </p> 5152</td><td><p> </p> 5153<p> </p> 5154<p>Y</p> 5155<p> </p> 5156<p> </p> 5157</td><td><p> </p> 5158<p> </p> 5159<p>Y</p> 5160<p> </p> 5161<p> </p> 5162</td><td><p> </p> 5163<p> </p> 5164<p>N/A</p> 5165<p> </p> 5166<p> </p> 5167</td><td><p> </p> 5168<p> </p> 5169<p> </p> 5170<p> </p> 5171<p> </p> 5172</td><td><p> </p> 5173<p> </p> 5174<p> </p> 5175<p> </p> 5176<p> </p> 5177</td></tr><tr><td><p> </p> 5178<p> </p> 5179<p>97157</p> 5180<p> </p> 5181<p> </p> 5182</td><td><p> </p> 5183<p> </p> 5184<p>Y</p> 5185<p> </p> 5186<p> </p> 5187</td><td><p> </p> 5188<p> </p> 5189<p>Y</p> 5190<p> </p> 5191<p> </p> 5192</td><td><p> </p> 5193<p> </p> 5194<p>Y</p> 5195<p> </p> 5196<p> </p> 5197</td><td><p> </p> 5198<p> </p> 5199<p>N</p> 5200<p> </p> 5201<p> </p> 5202</td><td><p> </p> 5203<p> </p> 5204<p>N/A</p> 5205<p> </p> 5206<p> </p> 5207</td><td><p> </p> 5208<p> </p> 5209<p> </p> 5210<p> </p> 5211<p> </p> 5212</td></tr><tr><td><p> </p> 5213<p> </p> 5214<p>97158</p> 5215<p> </p> 5216<p> </p> 5217</td><td><p> </p> 5218<p> </p> 5219<p>Y</p> 5220<p> </p> 5221<p> </p> 5222</td><td><p> </p> 5223<p> </p> 5224<p>N</p> 5225<p> </p> 5226<p> </p> 5227</td><td><p> </p> 5228<p> </p> 5229<p>N</p> 5230<p> </p> 5231<p> </p> 5232</td><td><p> </p> 5233<p> </p> 5234<p>Y</p> 5235<p> </p> 5236<p> </p> 5237</td><td><p> </p> 5238<p> </p> 5239<p>Y</p> 5240<p> </p> 5241<p> </p> 5242</td><td><p> </p> 5243<p> </p> 5244<p>N/A</p> 5245<p> </p> 5246<p> </p> 5247</td></tr></tbody></table> 5248<p> </p> 5249<p><b>Basic claim status inquiries</b></p> 5250<p>December 8, 2021</p> 5251<p>Providers performing basic claim status inquiries must now use <a href="https://infocenter.humana-military.com/prov/service/Account/Login" target="_blank" data-ispdf="false" data-iscta="false" rel="noopener noreferrer">provider self-service</a> or the automated claim status function by calling (800) 444-5445. Basic status inquiries sent via secure message or chat will also be directed back to self-service.</p> 5252<p>Basic claim status inquiries include details available in self-service like claim status, processed and paid date, billed and allowed amounts, amount paid and more.</p> 5253<p>Any claims issues or questions not related to basic claim status will be performed via the call center as normal.</p> 5254<p> </p> 5255<p><b>Cologuard⢠referral is no longer required for TRICARE Prime benef
5255iciaries, effective 6/1/22</b></p> 5256<p>UPDATE: May 5, 2022</p> 5257<p>Exact Science has now joined the network and referrals are no longer required for dates of service on or after 6/1/22.</p> 5258<p><a href="https://www.humanamilitary.com/content/dam/sites/humana-military-com/provider/tipsheets/covered-clinical-preventive-services.pdf" target="_blank" data-ispdf="true" data-iscta="false" rel="noopener noreferrer">Find out more about colorectal cancer screenings and other covered clinical preventive services</a></p> 5259<p> </p> 5260<p>November 10, 2021</p> 5261<p>TRICARE will cover stool DNA testing (e.g. Cologuardâ¢) once every one to three years starting at age 45 for those who have an average risk of colon cancer. Exact Science, (the only laboratory provider that offers Cologuard), is considered non-network for TRICARE Prime. Therefore, an approved referral is required for Prime beneficiaries prior to testing or <a href="https://www.humanamilitary.com/provider/refsauths#nucleustabs-6c75882e7c-item-ef6562f772-tab" target="_self" data-ispdf="false" data-iscta="false" rel="noopener noreferrer">Point of Service (POS)</a> will apply.</p> 5262<p> <br /> 5263</p> 5264<p><b>Clinical preventive services policy update</b></p> 5265<p>October 20, 2021</p> 5266<p>Effective May 18, 2021, TRICARE revised the clinical preventive services policy.</p> 5267<p>The following sections of the TRICARE policy manual were revised for clinical preventive services:</p> 5268<p>Colorectal cancer screening</p> 5269<ul><li><p>Revised coverage frequency and age limit for individuals at average risk from age 50 to age 45</p> 5270</li><li><p>Fecal Immunochemical Testing (FIT) of one stool sample once every 12 months beginning at age 45</p> 5271</li><li><p>Food and Drug Administration (FDA) approved Fecal Immunochemical Testing (FIT-DNA)
5271stool tests (e.g. Cologuardâ¢) once every one to three years beginning at age 45</p> 5272</li><li><p>Flexible sigmoidoscopy covered once every five years beginning at age 45</p> 5273</li><li><p>Computed Tomographic Colonography (CTC) covered once every five years beginning at age 45</p> 5274</li><li><p>Optical (conventional) colonoscopy covered once every 10 years beginning at age 45</p> 5275</li><li><p>Noted that screening guidelines are no longer specific to those with an increased risk</p> 5276</li><li><p>Incorporated the American Cancer Society definition of average risk</p> 5277</li><li><p>Removed the definition of increased risk</p> 5278</li></ul> 5279<p>Lung cancer screening</p> 5280<ul><li><p>Revised the frequency and age interval for lung cancer screening from 55 to 50 years of age</p> 5281</li><li><p>Pack per year history is additionally reduced from 30 to 20 packs per year</p> 5282</li></ul> 5283<p>Vision screening and services</p> 5284<ul><li><p>Revised routine eye exam language for retirees and their family members</p> 5285</li><li><p>Routine eye exams are not a covered benefit for retirees and eligible family members who are enrolled in TRICARE Select. Active Duty Family Members (ADFM) who are enrolled in TRICARE Select may receive a routine eye examine annually</p> 5286</li><li><p>Removed CPT codes 99172 - ocular function screen and 99173 - visual acuity screen from the manual</p> 5287</li></ul> 5288<p>For more information, including the full definition of average risk, view <a href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2023-01-06/AsOf/TP15/C7S2_1.html">TPM Chapter 7 Section 2.1</a></p> 5289<p> <br /> 5290</p> 5291<p><b>Updates to virtual health Place of Service (POS) and modifier</b></p> 5292<p>June 24, 2022</p> 5293<p>TRICARE updated its virtual health Place of Service (POS) codes for dates of service on or after Jan 1, 2022, and included adding POS 10 to the virtual health codes.</p> 5294<ul><li><p>POS virtual health codes</p> 5295</li></ul> 5296<ul><li><p>POS 02 â Virtual health provided other than in patientâs home: Healthcare services delivered through video conferencing technology in a setting outside of the beneficiaryâs home</p> 5297</li><li><p>POS 10 â Virtual health provided in patientâs home: Healthcare services delivered through videoconferencing technology in the beneficiaryâs home</p> 5298</li></ul> 5299<ul><li><p>Virtual health  and TRICARE</p> 5300</li></ul> 5301<ul><li><p>The use of secure video conferencing to deliver medically and psychologically necessary services to beneficiaries is covered by TRICARE. Providers should use one of the appropriate virtual health modifiers (95, GT or GQ) when billing POS 02 or POS 10. For more information on coverage and requirements, refer to TRICARE Policy Manual, Chapter 7, Section 22.1.</p> 5302</li></ul> 5303<p>For more information on CMS POS codes, visit <a href="https://www.cms.gov/">CMS.gov</a></p> 5304<p>October 18, 2021</p> 5305<p>When billing for synchronous virtual health services, providers will use CPT or Healthcare Common Procedure Coding System (HCPCS) codes with a GT or 95 modifier for distant site and Q3014 for originating site to distinguish virtual health services. In addition, POS 02 code may be reported in conjunction with GT or 95 modifier. However, POS 02 is not required to be reported through the end of the COVID-19 pandemic if a more appropriate code is necessary for correct billing, include POS code equal to what it would have been had the service been furnished in person. By coding and billing the GT or 95 modifier with a covered virtual health procedure code, the distant site provider certifies that the beneficiary was present at an eligible originating site when the virtual health service was furnished.</p> 5306<p>For billing asynchronous virtual health services, providers will use CPT or HCPCS codes with a GQ modifier. In addition, POS 02 may be reported in conjunction with the GQ modifier. However, POS 02 is not required to be reported through the end of the COVID-19 pandemic for virtual health claims if a more appropriate POS code is necessary for correct billing, include POS code equal to what it would have been had the service been furnished in person.</p> 5307<p>See <a href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2023-01-06/AsOf/TP15/C7S2_1.html">TRICARE Policy Manual, Chapter 7, Section 22.1, 2.3.2</a> for more information.</p> 5308<p> <br /> 5309<br /> 5310</p> 5311<p><b>Yearly provider claims update</b></p> 5312<p>September 24, 2021</p> 5313<p>As a reminder, TRICARE will be updating the annual Fiscal Year (FY) transactions necessary for FY 2022 from September 28 to October 1, 2021. During this time, claims will not be finalized for payment. We apologize for any inconvenience you may experience during this update.</p> 5314<p>Please see the below anticipated timeline for awareness and for the normal return to payment processing due to the transition:</p> 5315<ul><li><p>September 28-October 1: No processing for payments</p> 5316</li><li><p>October 1: Payment processing will slowly resume</p> 5317</li><li><p>October 6: Expectation to full, normal processing times</p> 5318</li></ul> 5319<p>*Please note: During this time, provider self-service may indicate a claim has been paid, but it may not have been processed.</p> 5320<p> <br /> 5321<br /> 5322</p> 5323<p><b>Freestanding ER claims verification</b></p> 5324<p>September 13, 2021</p> 5325<p>Humana Military is working diligently with the Defense Health Agency (DHA) to resolve the matter of the recoupments from freestanding Emergency Room (ER) claims that are currently on hold. We are moving forward to find a solution pending DHA's decision from its "emergency services rendered by non-authorized providers" policy.</p> 5326<p> </p> 5327<p>See <a href="https://www.humanamilitary.com/content/dam/sites/humana-military-com/provider/faqs/freestanding-er-faqs.pdf" target="_blank" data-ispdf="true" data-iscta="false" rel="noopener noreferrer">Freestanding ER FAQ's</a> for more information.</p> 5328<p> <br /> 5329<br /> 5330</p> 5331<p><b>Durable Equipment (DE) and Durable Medical Equipment (DME), Prosthetics, Orthotics, And Supplies (DMEPOS)</b></p> 5332<p>September 3, 2021</p> 5333<p>Reimbursement for Durable Equipment (DE) and Durable Medical Equipment (DME), Prosthetics, Orthotics and Supplies (DMEPOS) is established by an all-inclusive DMEPOS fee schedule. Currently, the reimbursement rates are based on Medicareâs DMEPOS and Parenteral and Enteral Nutrition (PEN) fee schedule amount. If there is no Medicare rate, the DE or DMEPOS item or service will be reimbursed using state prevailing rates.</p> 5334<p>Starting November 11, 2021, reimbursement rates will use the following methodology:</p> 5335<ul><li><p>The reimbursement rate is based on Medicareâs DMEPOS and PEN fee schedule amount. The pricing files are available on the <a href="https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/DMEPOSFeeSched">CMS website</a></p> 5336</li><li><p>If there is no Medicare rate, the DE or DMEPOS item or service will be reimbursed using TRICAREâs DMEPOS fee schedule rates.</p> 5337</li><li><p>If there is no Medicare or TRICARE DMEPOS fee schedule rate, the DE or DMEPOS item or service will be reimbursed using state prevailing rates.</p> 5338</li></ul> 5339<p>When billing DE, DMEPOS, or PEN items, the provider must:</p> 5340<ul><li><p>report the number of units based on the description of the Health Common Procedure Coding System (HCPCS) code and</p> 5341</li><li><p>
5341always include the modifier code RR on rental items and modifier code UE on used items. Any HCPCS codes billed with the UE modifier will result in a 25% reduction in the purchase rate listed in the TRICARE DMEPOS fee schedule.</p> 5342</li></ul> 5343<p>The fee schedule and periodic adjustments will be posted on the <a href="https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement/Durable-Medical-Equipment-Prosthetics-Orthotics-and-Supplies">DHA website</a></p> 5344<p>See the <a href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2023-01-06/AsOf/TR15/C1S11.html">TRICARE Reimbursement Manual (TRM) Chapter 1, Section 11</a> for more information.</p> 5345<p>Wigs and hairpieces</p> 5346<p>TRICARE covers one wig (also known as cranial prosthesis) or hairpiece per beneficiary (lifetime maximum) when the attending physician certifies that alopecia has resulted from the treatment of a malignant disease and the beneficiary certifies that a wig or hairpiece has not been obtained previously through the U.S. Government. This includes the Department of Veterans Affairs/Veterans Health Administration (DVA/ VHA). For more information on this benefit, refer to <a href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2023-01-06/AsOf/TP15/C8S12_1.html">TRICARE Policy Manual (TPM) Chapter 8, Section 12.1</a></p> 5347<p>For Calendar Year (CY) 2021, the allowable charge per wig or hairpiece cannot exceed the published CY rate of $2,388. If the wig or hairpiece exceeds this maximum amount, the reimbursement will be up to the allowable amount. The government will update this amount annually using the Consumer Price Index-Urban (CPI-U).</p> 5348<p>Â </p> 5349<p>08/31/2021</p> 5350<p>DHA extends deadline to submit new participation agreement</p> 5351<p>Due to a low response from Autism Corporate Service Providers (ACSP) in submitting a new participation agreement to remain TRICARE-authorized, the Defense Health Agency (DHA) has issued an extension through September 15, 2021.</p> 5352<p>Per TRICARE Operations Manual (TOM), ACSPs (including sole providers) must enter into a participation agreement. These providers practicing prior to July 1, 2021, must re-sign all of their participation agreements no later than September 15, 2021 or risk terminating their TRICARE- authorized status.</p> 5353<p>To fulfill the new policy requirement, ACSPs should <a href="https://infocenter.humana-military.com/HGBProvider/Providercertification/home/index?ProviderType=ACSP">submit a new certification</a> before September 15, 2021. See <a href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2022-12-30/AsOf/TO15/C18S4.html">TOM, Chapter 18, Section 4, paragraph 8.3</a> for more information on this requirement.</p> 5354<p>NOTE: Individual Behavior Analysts, Assistant Behavior Analysts, and Behavior Technicians working under tiered delivery models do not need to complete the ACSP application.</p> 5355<p><a href="https://infocenter.humana-military.com/HGBProvider/Providercertification/home/index?ProviderType=ACSP">Submit new certification now</a></p> 5356<p>Additional DHA-requested changes include:</p> 5357<p>Per <a href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2022-12-30/AsOf/TO15/C18S4.html">TOM Chapter 18, Section 4</a>, paragraph 8.2.1, all ABA practitioners must obtain a National Provider Identifier (NPI) number (all claims must have the rendering providerâs name and NPI for processing). Claims will deny for any ABA providers (including Assistant Behavior Analysts and Behavior Technicians) who did not possess an NPI prior to August 1, 2021. Visit <a href="http://infocenter.humana-military.com/prov/service/Account/Login" target="_blank" data-ispdf="false" data-iscta="false" rel="noopener noreferrer">self-service</a> to add or update an NPI.</p> 5358<p><a href="http://infocenter.humana-military.com/prov/service/Account/Login" target="_blank" data-ispdf="false" data-iscta="false" rel="noopener noreferrer">Add or update NPI</a></p> 5359<p>DHA also requires all ABA providers to submit claims and receive payments electronically (location-specific) through Electronic Media Claims (EMC) and Electronic Fund Transfers (EFT).</p> 5360<p><a href="https://www.humanamilitary.com/provider/claims#nucleustabs-04f885e556-item-8e100f9595-tab" target="_self" data-ispdf="false" data-iscta="false" rel="noopener noreferrer">Learn more about EMC and EFT</a></p> 5361<p>Â <br /> 5362Â </p> 5363<p>Â </p> 5364<p><b>Ablative Fractional Laser (AFL) treatment for burns and scars</b></p> 5365<p>August 30, 2021</p> 5366<p>Ablative Fractional Laser (AFL) treatment is approved under provisional coverage for emerging services and supplies. It includes Carbon Dioxide (CO2), Erbium, and Yttrium aluminum garnet laser treatments for symptomatic scars resulting from burns or other trauma.</p> 5367<p>AFL is covered for the treatment of symptomatic burns and scars with one or more of the following symptoms: itch, burn, pain, tightness, ulcerations or physical functional impairment.</p> 5368<p>Examples of physical functional impairment include, but are not limited to:</p> 5369<ul><li><p>decreased range of motion with use of associated body part</p> 5370</li><li><p>problems with communication, respiration, eating, swallowing</p> 5371</li><li><p>visual impairments</p> 5372</li><li><p>skin integrity</p> 5373</li><li><p>distortion of nearby body parts</p> 5374</li><li><p>obstruction of an orifice</p> 5375</li></ul> 5376<p>Preauthorization is NOT required.</p> 5377<p>AFL treatments are excluded for the following reasons:</p> 5378<ul><li><p>social, emotional and psychological impairment or potential impairments</p> 5379</li><li><p>solely for cosmetic purpose (unless otherwise covered under Chapter 4, Section 2.1)</p> 5380</li></ul> 5381<p>Procedure codes: 0479T OR 0480T</p> 5382<p>Reimbursement: Reimbursed as professional service, at rates equivalent to CPT codes 17280/17286
5382Note: Rates will be updated each time TRICARE updates the CHAMPUS Maximum Allowable Charge (CMAC) rates for CPT codes 17280/17286.</p> 5383<p>TED Special Processing Code: AT (Must be used since the codes are on the Government No Pay List â DHA is allowing us to bypass)</p> 5384<p>Effective dates are February 24, 2021 through February 23, 2026 (five years), with the implantation date of September 27, 2021.</p> 5385<p>See: <a href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2023-01-06/AsOf/TP15/C13S1_1.html">TRICARE Policy Manual Chapter 13, Section 1.1</a></p> 5386<p> <br /> 5387 </p> 5388<p> </p> 5389<p><b>Remote Physiologic Monitoring (RPM)</b></p> 5390<p>August 9, 2021</p> 5391<p>Medically necessary RPM services of physiologic parameter(s) including, but not limited to, weight, blood pressure, pulse oximetry and respiratory flow rate are covered when:</p> 5392<ul><li><p>The beneficiary requires RPM services of at least 20 minutes of clinical staff time directed by a TRICARE-authorized provider, per 30-day period; and</p> 5393</li><li><p>The beneficiary has a comprehensive care plan established, implemented, revised or monitored; and one of the following criteria are met:</p> 5394</li></ul> 5395<ul><li><p>The beneficiary has a chronic condition(s) that is expected to last at least 12 months, or until death of the beneficiary; or</p> 5396</li><li><p>The beneficiary has an acute condition(s) that place the beneficiary at significant risk of death, acute exacerbation/decompensation, or functional decline.</p> 5397</li></ul> 5398<p>Monitoring devices and equipment must be US Food and Drug Administration (FDA) approved and meet the definition of Durable Equipment (DE) and/or Durable Medical Equipment (DME). Examples of devices and equipment that do not meet TRICAREâs definition of DE/DME include personal computers, smartphones, tablets, smart watches, non-medical trackers and weight scales.</p> 5399<p>Covered services include:</p> 5400<ul><li><p>Set-up and patient/caregiver education on use of equipment (Current Procedural Terminology (CPT) code 99453);</p> 5401</li><li><p>Device supplies with daily recordings/alert transmission, each 30 days (CPT code 99454);</p> 5402</li><li><p>RPM treatment management services, TRICARE-authorized provider time per calendar month requiring interactive communication with the patient/caregiver for the first 20 minutes (CPT code 99457); and</p> 5403</li><li><p>The collection and interpretation of physiologic data digitally stored and/or transmitted by the patient/caregiver to the TRICARE- authorized provider with a minimum of 30 minutes of collection and interpretation time each 30 days (CPT code 99091).</p> 5404</li><li><p>Remote assessment of recorded video and/or images submitted (e.g., store and forward), including interpretation and follow-up with the beneficiary within 24 hours (HCPCS G2250).</p> 5405</li></ul> 5406<p>CPT procedure codes 99091, 99453, 99454, 99457, 99458 / HCPCS code G2250</p> 5407<p>RPM is considered an ancillary service as defined in <a href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2023-01-06/AsOf/TR15/C2S2.html">TRICARE Reimbursement Manual (TRM), Chapter 2, Section 2, paragraph 2.7.4</a>. Ancillary service cost-shares and copayments will apply.</p> 5408<p> <br /> 5409 </p> 5410<p> </p> 5411<p><b>A temporary work-around has been established to begin processing 2021 NO-PAY RAP claims</b></p> 5412<p>08/06/2021</p> 5413<p>WPS will begin processing HHA Request for Anticipated Payment (RAP) claims, bill type 322, with a work-around for the 2021 RAP NO-PAY processing guidelines.</p> 5414<p>The RAP claims will be processed with a temporary Denial Reason Code of 020. This charge is considered included in A Paid Service, until the final system update is completed and the actual DRC is moved into production along with the 2021 HHA pricer release.</p> 5415<p>When the Explanation of Benefit (EOB) is received with the 020 DRC, please disregard the statement that indicates to follow the steps to submit an allowable charge review for the RAP claim denial.</p> 5416<p>If there are any questions, please reach out to your local TRICARE Community Liaison (TCL) or a customer service representative for additional assistance.</p> 5417<p> <br /> 5418 </p> 5419<p> </p> 5420<p><b>COVID ABA virtual health expiration</b></p> 5421<p>August 5, 2021</p> 5422<p>Beneficiaries with current authorizations for CPT code 97156 (Patient/Caregiver Guidance) can no longer receive unlimited virtual health visits. Additional virtual health visits for parent training will require prior approval.</p> 5423<p>Beneficiaries who enter the Autism Care Demonstration (ACD) after August 1, 2021 cannot be administered care via virtual health for CPT code 97156 (Patient/Caregiver Guidance) until after the first six months of the authorization period.</p> 5424<p>Providers should be aware that the TRICARE Operations Manual (TOM) Chapter 18 Section 4 for ACD claims reimbursement will be followed.</p> 5425<p> <br /> 5426 </p> 5427<p> </p> 5428<p><b>ACSP must submit new certification request between July 1 and August 1</b></p> 5429<p>June 15, 2021</p> 5430<p>Due to the recent Autism Care Demonstration (ACD) changes in TRICARE ABA policy, all Autism Corporate Service Providers (ACSP) must submit a new participation agreement between July 1 and August 1, 2021 or risk terminating their TRICARE authorized status. ACSPs include autism centers, autism clinics, and sole providers (regardless of setting of rendered ABA services, i.e., home or clinic).</p> 5431<p>To fulfill the new policy requirement, ACSPs should visit this link: <br /> 5432<a href="https://infocenter.humana-military.com/HGBProvider/Providercertification/home/index?ProviderType=ACSP">Submit this new certification before August 1</a></p> 5433<p>See <a href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2022-12-30/AsOf/TO15/C18S4.html">TRICARE Operations Manual, Chapter 18, Section 4, paragraph 8.3</a> for more information on this requirement.</p> 5434<p>Note: Individual Behavior Analysts, Assistant Behavior Analysts, and Behavior Technicians working under tiered delivery models do not need to complete the ACSP application.</p> 5435<p> <br /> 5436 </p> 5437<p> </p> 5438<p><b>Autism Care Demonstration (ACD) balance billing limitation for non-participating providers</b></p> 5439<p>June 2, 2021</p> 5440<p>The balance billing provisions for non-participating providers as outlined in the <a href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2023-01-06/AsOf/TR15/C3S1.html">TRM, Chapter 3, Section 1 paragraph 4.0</a>, do not apply.</p> 5441<p>ABA providers may not bill a beneficiary more than 100% of the rates posted at <a href="https://health.mil/rates">Health.mil/rates</a></p> 5442<p> <br /> 5443 </p> 5444<p> </p> 5445<p><b>Reimbursement changes for Home Health Agencies (HHA)</b></p> 5446<p>February 6, 2023 - Update</p> 5447<p>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.</p> 5448<p>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.</p> 5449<p><a href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2023-01-06/AsOf/TR15/C12S9.html">TRICARE Reimbursement Manual Chapter 12, Section 9</a></p> 5450<p><a href="https://www.humanamilitary.com/content/dam/sites/humana-military-com/provider/faqs/HomeHealthAgency-reimbursement-faq.pdf" target="_blank" data-ispdf="true" data-iscta="false" rel="noopener noreferrer">Home Health Agency (HHA) reimbursement FAQs </a></p> 5451<p> <br /> 5452 </p> 5453<p>
5453June 15, 2022 - Update</p> 5454<p>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).</p> 5455<p> <br /> 5456 </p> 5457<p>March 4, 2022 - Update</p> 5458<p>Humana Military is awaiting the Defense Health Agencyâs 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 <a href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2023-01-06/AsOf/TR15/C12S9.html">TRICARE Reimbursement Manual Chapter 12, Section 9</a></p> 5459<p>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.</p> 5460<p> <br /> 5461 </p> 5462<p>May 26, 2021</p> 5463<p>Retroactive to January 1, 2021, TRICARE has implemented the following changes.<br /> 5464 </p> 5465<p><b>National Operating Standard Cost as a Share of Total Costs (NOSCASTC)</b></p> 5466<p>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.<br /> 5467 </p> 5468<p><b>Split percentage payments and Requests for Anticipated Payment (RAP)</b></p> 5469<p>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 âno payâ 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.<br /> 5470 </p> 5471<p><b>Low Utilization Payment Adjustment (LUPA)</b></p> 5472<p>For periods of care beginning on or after January 1, 2020, if an HHA provides fewer than the threshold of visits specified for the periodâs 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.</p> 5473<p>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.</p> 5474<p> </p> 5475<p>See the <a href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2023-01-06/AsOf/TR15/C12S9.html">TRICARE Reimbursement Manual, Chapter 12, Section 9</a> for more information.</p> 5476<p> <br /> 5477 </p> 5478<p> </p> 5479<p><b>Policy clarification for acute rehabilitation facilities</b></p> 5480<p>May 10, 2021</p> 5481<p>As a reminder, there is no limit to the number of days for TRICARE admissions to acute rehabilitation facilities. Admissions and continued lengths of stay are based on medical necessity. Recent changes to TRICARE reimbursement methodology for acute rehabilitation facilities does not impact the length of stay for rehabilitation admissions. Discharges or transitions to other levels of care should be based upon medical necessity and the beneficiaryâs overall treatment plan.</p> 5482<p>See the <a href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2023-01-06/AsOf/TP15/C7S18_2.html">TRICARE Policy Manual, Chapter 7, Section 18.2, Paragraph 3.1</a></p> 5483<p> <br /> 5484 </p> 5485<p> </p> 5486<p><b>Assistant Behavior Analysts and Behavior Technicians required to submit NPI by August 1, 2021</b></p> 5487<p>May 5, 2021</p> 5488<p>Due to a change in TRICARE ABA policy, all previously certified Assistant Behavior Analysts and Behavior Technicians must submit their National Provider Identifier (NPI) before August 1. This update must be made through <a href="https://infocenter.humana-military.com/prov/service/Account/LogIn" target="_blank" data-ispdf="false" data-iscta="false" rel="noopener noreferrer">provider self-service and not by phone.</a></p> 5489<p>This change has been put in place to reduce errors related to provider rates and ensure providers receive correct reimbursement. </p> 5490<p>See <a href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2021-04-27/AsOf/TO15/C18S4.html">TRICARE Operations Manual, paragraph 8.2.1</a> for more information on this requirement.</p> 5491<p> <br /> 5492 </p> 5493<p> </p> 5494<p><b>Organ acquisition services</b></p> 5495<p>May 12, 2022</p> 5496<p>Effective Oct. 28, 2019, TRICARE offers reimbursement for reasonable and necessary organ acquisition services and costs in support of quality organ transplant programs. Under Medicare, Certified Transplant Centers (CTC) and Organ Procurement Organizations (OPO) report these costs using the Centers for Medicare and Medicaid Services (CMS) Forms 2552 and 216. TRICARE will use the Medicare Standard Acquisition Charges (SAC) to determine reimbursement amounts.</p> 5497<p>The CTC must develop two SACs based on reasonable and necessary organ acquisition costs:</p> 5498<ol><li><p>A SAC for acquiring a living donor organ (estimated average charge for services provided to living donors and recipients of living donor organs)</p> 5499</li></ol> 5500<ol><li><p>A SAC for acquiring a cadaveric donor organ (estimated average charge for procuring cadaveric organs combined with expected costs of acquiring cadaveric organs from other sources)</p> 5501</li></ol> 5502<p>The SAC covers total costs for getting either live or cadaver organs. Solid organ procurement costs must be billed separately from inpatient claim with revenue codes 0811 or 0812 to be eligible for reimbursement.</p> 5503<p>TRICARE reimburses CTCs for organ acquisition one of two ways:</p> 5504<ol><li><p>Annually, providers should report SACs to Humana Military for organ acquisition costs for the fiscal year due July 31, 2022 by sending their information to <a href="mailto:HMHSPricingMailbox@humana.com">HMHSPricingMailbox@humana.com</a></p> 5505</li></ol> 5506<ol><li><p>If, for some reason, the provider is unable to report SAC by the deadline, TRICARE will use the hospitalâs overall operation cost-to-charge ratio to reduce charges.</p> 5507</li></ol> 5508<p>Use this <a href="https://www.humanamilitary.com/content/dam/sites/humana-military-com/provider/forms/miscellaneous/standard-acquisition-charges-sac-for-organ-acquisition.pdf" target="_blank" data-ispdf="true" data-iscta="false" rel="noopener noreferrer">SAC form</a> to gather your information to submit to us.</p> 5509<p>For more information, see the Organ Acquisition Costs section of the <a href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2023-01-06/AsOf/TR15/C1S40.html">TRICARE Reimbursement Manual, Chapter 1, Section 40</a></p> 5510<p>NOTE: If your point-of-contact information has changed, please send those updates to <a href="mailto:HMHSPricingMailbox@humana.com">HMHSPricingMailbox@humana.com</a><br /> 5511 </p> 5512<p><b>Hospital Value-Based Purchasing Program (HVBP)</b></p> 5513<p>March 31, 2021</p> 5514<p>TRICARE is adopting the Centers for Medicare and Medicaid Services (CMS) HVBP for hospitals, skilled nursing facilities and other institutional providers under the Inpatient Prospective Payment System (IPPS). This program will apply a claim-by-claim adjustment factor to the base Diagnosis Related Group (DRG) payment for claims in the fiscal year associated with the acute care hospital'
5514s performance period. The adjustment factor can be found in the <a href="https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS">CMS IPPS Final Rule Table</a></p> 5515<p>Exclusions include those facilities not included in the IPPS:</p> 5516<ul><li><p>Psychiatric hospitals</p> 5517</li><li><p>Rehabilitation hospitals</p> 5518</li><li><p>Long-term care hospitals</p> 5519</li><li><p>Childrenâs hospitals</p> 5520</li><li><p>Critical Access Hospitals (CAH)</p> 5521</li><li><p>Prospective Payment System-exempt TRICARE cancer hospitals</p> 5522</li><li><p>Hospitals in the state of Maryland</p> 5523</li><li><p>Hospitals located in Puerto Rico and other United States territories do not participate in HVBP. (If CMS decides at a later date to include these hospitals, TRICARE will also include them in HVBP)</p> 5524</li></ul> 5525<p>See the <a href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2024-10-16/AsOf/TR15/C1S41.html" target="_blank" data-ispdf="false" data-iscta="false" rel="noopener noreferrer">TRICARE Reimbursement Manual (TRM), Chapter 1, Section 41</a> for more information.</p> 5526<p> <br /> 5527 </p> 5528<p> </p> 5529<p><b>TRICARE adopts New Technology Add-On Payments (NTAP)</b></p> 5530<p>February 11, 2021</p> 5531<p>Effective January 1, 2020, TRICARE adopted the Centers for Medicare and Medicaid Services (CMS) New Technology Add-On Payments (NTAP) under the Medicare Inpatient Prospective Payment System (IPPS). NTAPs are special payments that are offered because new medical services and technologies are not yet included in the calculation of standardized Diagnosis Related Group (DRG) rates. A DRG is a patient classification system that standardizes prospective payment to hospitals and encourages cost-containment initiatives. By law, Medicare has established this reimbursement methodology to more appropriately pay for the costs of new medical services and technologies under the hospital IPPS.</p> 5532<p>CMS uses criteria set forth in regulation regarding the newness, clinical benefit and cost of a new technology to determine which treatments will receive an NTAP. To qualify as a NTAP, a specific technology will be ânewâ according to CMS regulations, specifically §412.87(b)(2). The statutory provision allows for special payment treatment for new technologies until they are incorporated into the DRG, which takes between two and three years. Once they are incorporated into the DRG, they are no longer considered NTAPs. For a complete list of NTAPs and reimbursement rules, visit the CMS <a href="https://www.cms.gov/medicare/payment/prospective-payment-systems/acute-inpatient-pps" target="_blank" data-ispdf="false" data-iscta="false" rel="noopener noreferrer">website</a>. The reimbursement amounts in the IPPS final rule represent the maximum add-on payment for each NTAP.</p> 5533<p>See the <a href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2024-10-16/AsOf/TR15/C6S11.html" target="_blank" data-ispdf="false" data-iscta="false" rel="noopener noreferrer">TRICARE Reimbursement Manual (TRM), Chapter 6, Section 11</a> for more information.</p> 5534<p> <br /> 5535 </p> 5536<p> </p> 5537<p><b>Known performance issues with eligibility checks</b></p> 5538<p>February 9, 2021</p> 5539<p>We are aware that some users may experience performance issues with eligibility checks (270/271). We are currently reviewing our real time process to address performance barriers.</p> 5540<p>270: Requests eligibility and benefit information from the patientâs insurance company.</p> 5541<p>271: Returns eligibility and benefit information of the patient. It is set to receive care from the insurance company to the provider of service.</p> 5542<p>Steps taken to date include:</p> 5543<ul><li><p>Established a problem record to track all changes and results.</p> 5544</li><li><p>Adjusted memory allocation to constrained resources.</p> 5545</li><li><p>Reviewed anti-virus and other scanning tools for any links between scans and performance degradation.</p> 5546</li><li><p>Full engagement of vendor and enterprise resources on application configuration tuning to return performance to a reliable state.</p> 5547</li></ul> 5548<p>The Electronic Data Interchange (EDI) team continues to push out proactive notifications to our trading partners and clearinghouses as we work through this issue.</p> 5549<p> <br /> 5550 </p> 5551<p> </p> 5552<p><b>Home Health Value-Based Purchasing (HHVBP) demonstration</b></p> 5553<p>January 14, 2021</p> 5554<p>Effective for dates of service, retroactive to January 1, 2020, Home Health Agencies (HHA) will be required to adopt the Medicare HHVBP model in TRICAREâs HHA Prospective Payment System (PPS) using the report published on the Centers for Medicare and Medicaid Services (CMS) <a href="https://innovation.cms.gov/innovation-models/home-health-value-based-purchasing-model">website</a></p> 5555<p>The following states will be impacted by this demonstration: Florida, Maryland, Massachusetts, North Carolina and Tennessee (East Region) and Arizona, Iowa, Nebraska and Washington (West Region).</p> 5556<p>If you are a HHA impacted by this change, and have any questions about this demonstration, please contact us at <a href="mailto:HMHSPricingMailbox@humana.com">HMHSPricingMailbox@humana.com</a></p> 5557<p> <br /> 5558 </p> 5559<p> </p> 5560<p><b>TRICARE Low Back Pain (LBP) and Physical Therapy (PT) demonstration</b></p> 5561<p>January 11, 2021</p> 5562<p>Beginning January 1, 2021, the Defense Health Agency (DHA) has approved a demonstration to waive the cost-share for up to three PT sessions for benef
5562iciaries with LBP. The purpose of the demonstration is to evaluate if waiving cost-shares for up to three PT sessions will increase beneficiary PT participation, decrease low-value care and/or decrease the overall cost of care for treating beneficiaries with LBP.</p> 5563<p>This demonstration will run from January 1, 2021 through December 31, 2023 and will operate in the following states: Arizona, California, Colorado, Florida, Georgia, Kentucky, North Carolina, Ohio, Tennessee and Virginia.</p> 5564<p>See the <a href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2024-12-23/AsOf/TO15/C18S9.html" target="_blank" data-ispdf="false" data-iscta="false" rel="noopener noreferrer">TRICARE Operations Manual, Chapter 18, Section 9</a> for more information.</p> 5565<p>Â <br /> 5566Â </p> 5567<p>Â </p> 5568<p><b>TRICARE covers certain COVID clinical trials</b></p> 5569<p>December 11, 2020</p> 5570<p>Effective October 30, 2020, clinical trials sponsored by or in collaboration with the National Institute of Allergy and Infectious Disease (NIAID) will be covered for the treatment and prevention of COVID-19. This change is effective for the duration of the presidentâs national emergency regarding COVID-19; however, if a beneficiary has been enrolled in a NIAID-sponsored trial during the national emergency, they will continue to have their cost shared for the duration of the trial, even if the public health emergency has ended.</p> 5571<p>Please use Special Processing Code (SPC) âCO â NIAID COVID-19 Clinical Trialsâ to identify these TRICARE Encounter Data (TED) records. This new code should be used in conjunction with âCCâ whenever COVID-19 testing is included as part of a NIAID clinical trial. SPC âCOâ should not be coded on the TED records with SPC âCV.â</p> 5572<p>Â <br /> 5573Â </p> 5574<p>Â </p> 5575<p><b>TRICARE expands coverage of investigational drugs</b></p> 5576<p>December 11, 2020</p> 5577<p>Effective September 30, 2020, TRICARE has expanded coverage for the use of investigational drugs to treat serious or life-threatening cases of COVID-19 infection or its associated sequelae. The drugs must be approved by the US Food and Drug Administration (FDA) and administered in an FDA-approved setting.</p> 5578<p>Â <br /> 5579Â </p> 5580<p>Â </p> 5581<p><b>New treatment approved for Obstructive Sleep Apnea (OSA)</b></p> 5582<p>December 11, 2020</p> 5583<p>Effective August 15, 2019, implantable Hypoglossal Nerve Stimulation (HGNS) under Common Procedure Terminology (CPT) codes 64568 and 0466T is a covered benefit for the treatment of moderate-to-severe Obstructive Sleep Apnea (OSA).</p> 5584<p>See the <a href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2024-12-30/AsOf/TP15/C4S8_1.html" target="_blank" data-ispdf="false" data-iscta="false" rel="noopener noreferrer">TRICARE Policy Manual (TPM), Chapter 4, Section 8.1</a> for more information.</p> 5585<p>Â <br /> 5586Â </p> 5587<p>Â </p> 5588<p><b>Diagnostic imaging for acute Low Back Pain (LBP)</b></p> 5589<p>December 11, 2020</p> 5590<p>Effective October 30, 2020, <a href="https://tricare.mil/CoveredServices/IsItCovered/DiagnosticImagingLBP">TRICARE</a> no longer provides diagnostic imaging coverage for beneficiaries with acute Low Back Pain (LBP) within six weeks of symptom onset if there were no warning signs.</p> 5591<p>If there are clinical warning signs to justify imaging within six weeks of acute low back pain onset, providers should bill with the appropriate secondary diagnosis code.</p> 5592<p>See the <a href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2024-12-30/AsOf/TP15/C5S1_1.html" target="_blank" data-ispdf="false" data-iscta="false" rel="noopener noreferrer">TRICARE Policy Manual (TPM) Chapter 5, Section 1.1</a> for more information.</p> 5593<p>Â <br /> 5594Â </p> 5595<p>Â </p> 5596<p><b>New claims modifiers for breast pump supplies</b></p> 5597<p>Update: December 10, 2020</p> 5598<p>The new policy allows only the breast pump and the following replacement parts without an additional prescription:</p> 5599<ul><li><p>Two bottles and caps or locking rings once a year after a birth event</p> 5600</li><li><p>One replacement power adapter per birth event and none within the first 12 months (Please use HCPCS code A4282 only for breast pump power adapters)</p> 5601</li><li><p>12 valves or membranes once a year</p> 5602</li><li><p>One set of flanges per birth event</p> 5603</li><li><p>One set of tubing</p> 5604</li><li><p>90 breast milk bags every 30 days after the birth</p> 5605</li></ul> 5606<p>Â </p> 5607<p><b>Update: October 7, 2019</b></p> 5608<p>Following a birth event, TRICARE allows 90 breast milk bags, every 30 days. In order to get paid correctly, providers must bill for the actual number of milk bags supplied (90), and not for a single (one) box of breast milk bags.</p> 5609<p>Â </p> 5610<p>June 26, 2019</p> 5611<p>TRICARE recently revised the breast pump/breast pump supply benefit to include limits on what is covered. The changes affirm coverage of breast pumps for new mothers and adoptive mothers and allow expecting moms to access the benefit starting at the 27th week of pregnancy, or when the baby is born, if premature.</p> 5612<p>In order to correctly reimburse for breast pump supplies using unlisted Healthcare Common Procedure Coding System (HCPCS) codes A9900 or A9999, providers need to use the following modifiers:</p> 5613<ul><li><p>Supply - Modifier</p> 5614</li><li><p>Replacement valves/membranes - XG</p> 5615</li><li><p>Replacement breast milk storage bags - XH</p> 5616</li><li><p>Replacement nipple shields - XD</p> 5617</li></ul> 5618<ul><li><p>Supplemental nursing system - XN</p> 5619</li><li><p>Breast pump kit - XR</p> 5620</li></ul> 5621<p>Both the TRICARE East and TRICARE West regions are implementing these guidelines.</p> 5622<p>A supplemental nursing system, two sets of flanges and replacement supplies in addition to the above limits may be covered with a prescription that is specific to the supplies that are needed.</p> 5623<p>Additionally, TRICARE added a payment cap for manual and standard electric breast pumps. All related supplies needed for the operation of the breast pump are included in the cap amount. As of March 2019, TRICARE pays $312.84 for stateside and $500.55 for overseas. For more about these rates, visit <a href="https://health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement/Durable-Medical-Equipment-Prosthetics-Orthotics-and-Supplies" target="_blank" data-ispdf="false" data-iscta="false" rel="noopener noreferrer">health.mil</a></p> 5624<p>Â <br /> 5625Â </p> 5626<p>Â </p> 5627<p><b>Delays in Primary Care Manager (PCM) assignment times</b></p> 5628<p>October 22, 2020</p> 5629<p>Please note: Due to a programming issue, we are experiencing delays in Primary Care Manager (PCM) assignment times for TRICARE Prime benef
5629iciaries. We are working diligently to correct this issue and all PCM records should be updated by late December.</p> 5630<p>There is no need to postpone care for these beneficiaries and your claims payment should not be affected. There is no action required from you at this time.</p> 5631<p> <br /> 5632<br /> 5633</p> 5634<p><b>COVID-19 serology testing</b></p> 5635<p>October 6, 2020</p> 5636<p>COVID-19 serology/antibody testing is covered by TRICARE only when medically necessary and when the results of the test will impact the clinical management of the beneficiary. For example, if a beneficiary exhibits late symptoms or sequelae of COVID-19, testing would be covered.</p> 5637<p>It is not covered for general screening in asymptomatic individuals, to determine immunity from past infection, or for return to work/school purposes.</p> 5638<p>For further guidance on COVID-19 serology/antibody testing, refer to CDC guidance on the proper use of COVID-19 serology testing. The Military Health System (MHS) follows <a href="https://www.cdc.gov/covid/testing/index.html" target="_blank" data-ispdf="false" data-iscta="false" rel="noopener noreferrer">CDC guidelines</a>, while most civilian healthcare plans follow the CARES act.</p> 5639<p> <br /> 5640<br /> 5641</p> 5642<p><b>Prescription Monitoring Program (PMP) update</b></p> 5643<p>September 17, 2020</p> 5644<p>The TRICARE Prescription Monitoring Program (PMP) is a quarterly review of beneficiaries receiving prescriptions for controlled substances and has been expanded to include a review of providers issuing prescriptions for controlled substances. Goals of the PMP include identifying beneficiaries who may benefit from additional assistance and education, as well as monitoring provider controlled substance prescribing practices.</p> 5645<p>Each quarter, the Defense Health Agency (DHA) will provide Humana Military with a list of East Region providers that have written prescriptions for controlled substances. Humana Military will review the report, and reach out to providers for additional information if needed. Humana Military may recommend clinical resources to the prescribing provider with the goal of increasing beneficiary safety and effectiveness of treatment. Find more information on this program in the <a href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2024-12-23/AsOf/TO15/C28TOC.html" target="_blank" data-ispdf="false" data-iscta="false" rel="noopener noreferrer">TRICARE Operations Manual, Chapter 28</a></p> 5646<p>A secure, searchable tool is available to network providers through <a href="https://infocenter.humana-military.com/provider/service/Account/Login">provider self-service</a></p> 5647<p> <br /> 5648 </p> 5649<p> </p> 5650<p><b>New guidance on virtual health Intensive Outpatient Programs (IOP) and half-day Partial Hospitalization Programs (PHP)</b></p> 5651<p>July 17, 2020</p> 5652<p>The Defense Health Agency (DHA) has issued new guidance on the use of virtual health for TRICARE-covered diagnostic and treatment services. Services must be medically or psychologically necessary and appropriate.</p> 5653<p>IOP guidelines</p> 5654<ul><li><p>Two to less than six-hour outpatient program taking place in an organized setting, day or evening.</p> 5655</li><li><p>Providers may carry out some IOP services via virtual health (for example, individual psychoeducation, case management, recreational therapy, etc.). Virtual health does not cover: drug screening, group psychotherapy and some other services.</p> 5656</li><li><p>TRICARE policy requires a referral OR prior authorization for IOP care.</p> 5657</li><li><p>The IOP or half-day PHP providing services by virtual health must be at the same intensity and level of service required by those programs per policy. The provider must show they are offering all components of the IOP via virtual health (e.g., at least two hours of services). IOPs and half-day PHPs must document all services via virtual health in the medical records and on the claim.</p> 5658</li></ul> 5659<p>Please note: Full-day (any services lasting six hours or longer), full-intensity PHP services provided under virtual health are not currently covered.</p> 5660<p>Billing guidelines</p> 5661<p>Providers should hold their claims until after August 10, 2020. After August 10, please submit claims using the modifier GT and revenue code 0780.</p> 5662<p>See the <a href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2021-03-26/AsOf/tp15/c7s22_1.html">TRICARE Policy Manual, Chapter 7, Section 22.1</a> for more information.</p> 5663<p> <br /> 5664 </p> 5665<p> </p> 5666<p><b>TRICARE and fetal surgery</b></p> 5667<p>July 16, 2020</p> 5668<p>If a beneficiary under your care requires fetal surgery, Humana Military has a dedicated phone line with case managers standing by to assist. Please contact our Integrated Care Team at (800) 881-9227.</p> 5669<p> <br /> 5670 </p> 5671<p> </p> 5672<p>TRICARE updates Skilled Nursing Facility (SNF) admission policy</p> 5673<p>July 10, 2020</p> 5674<p>TRICARE follows Medicare requirements for admission to a Skilled Nursing Facility (SNF). For admission to be covered, the beneficiary must have a qualifying hospital stay of at least three consecutive days (not including the hospital discharge day) and be admitted to the SNF within 30 days of hospital discharge.</p> 5675<p>Effective October 1, 2019, TRICARE adopted the Medicare Interrupted Stay Policy. Medicare defines an interrupted stay as one in which a beneficiary is discharged from a SNF and readmitted to the same SNF during the interruption window, which is a three-day period beginning on the first non-covered day following a SNF stay and ends at 11:59 PM on the third consecutive non-covered day. If these conditions are met, the subsequent stay is considered a continuation of the previous âinterruptedâ stay for the purposes of both the variable per diem and assessment schedules.</p> 5676<p>If the beneficiary is readmitted to the same SNF outside the interruption window or to another SNF, regardless of the length of time between stays, the Interrupted Stay Policy does not apply, and the subsequent admission will be considered a ânew stay.â In this case, the variable per diem schedule will reset to Day 1 payment rates, and the assessment schedule will reset to Day 1, which will necessitate a new five-day assessment.</p> 5677<p>See the <a href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2024-10-16/AsOf/TR15/C8S2.html" target="_blank" data-ispdf="false" data-iscta="false" rel="noopener noreferrer">TRICARE Reimbursement manual, Chapter 8, Section 2</a> for more information.</p> 5678<p> <br /> 5679<br /> 5680</p> 5681<p><b>TRICARE coverage of Continuous Glucose Monitoring Systems (CGMS)</b></p> 5682<p>July 9, 2020</p> 5683<ul><li><p>On January 1, 2020, TRICARE revised its CGMS benefit to allow beneficiaries with uncontrolled diabetes the use of FDA-approved CGMS.</p> 5684</li><li><p>TRICARE coverage includes both therapeutic and non-therapeutic devices.</p> 5685</li><li><p>Therapeutic CGMS is defined as a device that is approved by the FDA for non-adjunctive use (i.e., used as a replacement for finger stick BGM testing). Therapeutic (non-adjunctive) CGMS and supplies shall be reported utilizing HCPCS codes K0553-K0554 (or subsequent codes if replaced or renumbered). Devices that are labeled for use as therapeutic (non-adjunctive), even if the patient continues to perform glucose self-testing (e.g., finger sticks), shall be reported utilizing these codes.</p> 5686</li><li><p>Non-therapeutic CGMS is defined as a device that is approved by the FDA for use to complement, not replace, information obtained from finger stick testing. Adjunctive (non-therapeutic) CGMS and supplies should be reported with A9276 - A9278 (or subsequent codes if replaced or renumbered), with providers reminded of the requirement to use the most appropriate code for the service rendered. Only those devices which are not labeled by the FDA for therapeutic use (i.e., adjunctive, or only labeled to complement but not replace standard blood glucose monitoring) may be reported utilizing these codes.</p> 5687</li></ul> 5688<ul><li><p>Specific criteria must be met for coverage, as outlined in TPM Chapter 8, Section 5.3. A benefit review determination is available and encouraged for the initial system.</p> 5689</li></ul> 5690<p>Providers should submit CGMS requests, and <a href="https://www.humanamilitary.com/content/dam/sites/humana-military-com/provider/forms/miscellaneous/continuous-gluc
5690ose-monitor-attestation-form.pdf" target="_blank" data-ispdf="true" data-iscta="false" rel="noopener noreferrer">attach the Continuous glucose monitor attestation form</a>, online through <a href="https://infocenter.humana-military.com/provider/service/Account/Login">provider self-service</a></p> 5691<p> <br /> 5692<br /> 5693</p> 5694<p><b>Portable CPAP now covered</b></p> 5695<p>July 8, 2020</p> 5696<p>Under TRICAREâs Durable Medical Equipment (DME) benefit, beneficiaries who have been diagnosed with obstructive sleep apnea syndrome or respiratory insufficiency, may be eligible to receive a Continuous Positive Airway Pressure (CPAP) machine. Prior authorization is required for this limited benefit.</p> 5697<p>TRICARE may also cover a portable CPAP machine for Active Duty Service Members (ADSM) with a referral that states the beneficiary:</p> 5698<ul><li><p>has a diagnosis of obstructive sleep apnea</p> 5699</li><li><p>travels on official business at least three days per month, or is being deployed</p> 5700</li><li><p>is not retiring or separating from the military within the year</p> 5701</li></ul> 5702<p>Please note:</p> 5703<ul><li><p>The portable device must have humidification and battery capability.</p> 5704</li><li><p>If the beneficiary has a standard CPAP machine, a portable machine is covered if the above conditions are met. TRICARE will not authorize a standard CPAP machine if the beneficiary already has a portable machine.</p> 5705</li></ul> 5706<p>Billing guidelines:</p> 5707<p>Please provide a description and bill under Healthcare Common Procedure Coding System (HCPCS) code E1399.</p> 5708<p>See additional information about <a href="https://tricare.mil/CoveredServices/IsItCovered/CPAPMachine">TRICARE CPAP machine benefit, conditions and exclusions</a></p> 5709<p> <br /> 5710<br /> 5711</p> 5712<p><b>TRICARE temporarily revises virtual health benefit</b></p> 5713<p>June 17, 2020</p> 5714<p>As virtual health continues to play an important role in healthcare, TRICARE has updated its policy on the coverage and expansion of services, costs and other benefits.</p> 5715<p>May 19, 2020 updated temporary benefits include:</p> 5716<ul><li><p>Audio-only healthcare visits are now covered</p> 5717</li><li><p>No out-of-pocket costs for covered virtual health services</p> 5718</li></ul> 5719<p>TRICARE will now waive cost-shares, copayments and deductible (if applicable) for covered virtual health services from a military provider or TRICARE network provider. This waiver applies to all covered in-network virtual health services, not just the services related to COVID-19.</p> 5720<p>More providers able to offer covered virtual health services</p> 5721<p>Prior to the stateside public health emergency, TRICARE policy required providers to have a license in the state where they practice and where the patient lives. TRICARE will now reimburse providers for interstate care to patients. The care must be permitted by federal or state licensing laws.</p> 5722<p> <br /> 5723<br /> 5724</p> 5725<p><b>TRICARE manuals now include a Patient-Driven Payment Model (PDPM) for Skilled Nursing Facility (SNF) reimbursement</b></p> 5726<p>June 9, 2020</p> 5727<p>Retroactive to October 1, 2019, TRICARE has adopted the Medicare Skilled Nursing Facility (SNF) Prospective Payment System (PPS) payment methods, including Minimum Data Set (MDS) assessments, Patient-Driven Payment Model (PDPM) classifications and Medicare weights and per diem rates.</p> 5728<p>TRICAREâs PDPM model</p> 5729<p>Under PDPM, there are six payment components. Five are case-mix adjusted to allow for diagnostic variances and illness severity; the sixth is non-case-mix adjusted and covers SNF resources that do not vary according to beneficiary characteristics.</p> 5730<ul><li><p>Physical Therapy (PT) â includes a variable per diem factor</p> 5731</li><li><p>Occupational Therapy (OT) â includes a variable per diem factor</p> 5732</li><li><p>Speech Language Pathology (SLP)</p> 5733</li><li><p>Nursing</p> 5734</li></ul> 5735<ul><li><p>Non-Therapy Ancillary (NTA) services â includes a variable per diem factor</p> 5736</li></ul> 5737<p>See the <a href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2023-01-06/AsOf/TR15/C8S2.html">TRICARE Reimbursement Manual, Chapter 8, Section 2</a> for more information.</p> 5738<p> <br /> 5739 </p> 5740<p> </p> 5741<p><b>Physical Therapy Assistants (PTA) and Occupational Therapy Assistants (OTA) are now covered by TRICARE</b></p> 5742<p>June 8, 2020</p> 5743<p>Effective April 16, 2020, TRICARE has approved Physical Therapy Assistants (PTA) and Occupational Therapy Assistants (OTA) as TRICARE-authorized providers under the supervision of a TRICARE-authorized, licensed and registered physical therapist or occupational therapist in accordance with Medicareâs rules for supervision and qualification.</p> 5744<p>Per TRICARE guidelines, PTAs and OTAs may not:</p> 5745<ul><li><p>Provide an initial examination</p> 5746</li><li><p>Provide an evaluation</p> 5747</li><li><p>Provide a re-evaluation and/or assessment</p> 5748</li><li><p>Establish a diagnosis</p> 5749</li><li><p>Establish a plan of care</p> 5750</li></ul> 5751<p>When submitting claims, please follow these guidelines:</p> 5752<ul><li><p>Use the CQ modifier when submitting claims for services performed in whole or in part by a PTA</p> 5753</li><li><p>Use the CO modifier when submitting claims for services performed in whole or in part by an OTA</p> 5754</li></ul> 5755<p> <br /> 5756 </p> 5757<p> </p> 5758<p><b>TRICARE manuals now include a Patient-Driven Groupings Model (PDGM) for Home Health Agency (HHA) reimbursement</b></p> 5759<p>May 19, 2020</p> 5760<p>Retroactive to January 1, 2020, TRICARE manuals now include a Patient-Driven Groupings Model (PDGM) for Home Health Agency (HHA) reimbursement. Humana Military will release PDGM-reimbursed HHA claims with dates of service on or after January 1 as soon as system changes are implemented.</p> 5761<p>TRICAREâs PDGM model</p> 5762<p>TRICAREâs PDGM reimbursement model closely follows Medicareâs PDGM*.</p> 5763<ul><li><p>Reimbursement is based on 30-day periods of care vs. 60-day episodes**.</p> 5764</li><li><p>Therapy thresholds are no longer used to determine payments. Reimbursement is based on timing, admission source, clinical group, functional impairment level and comorbidity adjustment.</p> 5765</li><li><p>Health Insurance Prospective Payment System (HIPPS) codes are still reported with revenue code 0023.</p> 5766</li></ul> 5767<p>*Unlike Medicare, TRICARE requires a Treatment Authorization Code (TAC). <br /> 5768**Authorizations for home health services, OASIS assessments and updates to patient care plans remain on a 60-day period of c
5768are.</p> 5769<p> </p> 5770<p>Reimbursement</p> 5771<p>Except for low utilization HHAs, providers must submit an initial claim, also called a Request for Anticipated Payment (RAP), and a final claim. Providers must bill in non-overlapping 30-day periods of care.</p> 5772<ul><li><p>For 60-day episodes that began on or before December 31, 2019 and span into 2020, payment will be for the 60-day episode. For 30-day periods of care that start on our after January 1, 2020, reimbursement is based on 30-days.</p> 5773</li><li><p>HHAs participating in Medicare prior to January 1, 2019 will continue to receive RAP payments, now a 20/80 split. Those who began participating in Medicare on or after January 1, 2019 will receive an entire payment with the final claim.</p> 5774</li><li><p>HHAs with low utilization (two to six visits per 30-day period) will be paid a standardized per visit payment instead of payment for a 30-day period of care.</p> 5775</li></ul> 5776<p>Medicare updates rates annually on a calendar year basis.</p> 5777<p>Note: This guidance does not apply to home health services provided to Active Duty Family Members (ADFM) under the Extended Care Health Option (ECHO).</p> 5778<p> <br /> 5779 </p> 5780<p> </p> 5781<p><b>Already-approved referrals and authorizations have been extended 180 days from the expiration date</b></p> 5782<p>May 18, 2020</p> 5783<p>With provider offices across the country rescheduling patient appointments due to the COVID-19 outbreak, we recognize some already-approved authorizations for TRICARE beneficiaries may expire before pandemic restrictions are lifted. In an effort to reduce administrative burden for providers, we have automatically extended certain outpatient referrals and authorizations an additional 180 days. Humana Military has automatically updated the referral/authorization end dates and the updates are reflected in provider self-service.</p> 5784<p>Key points</p> 5785<ul><li><p>We have extended already-approved outpatient referrals and authorizations that expire(d) between March 1, 2020 and June 30, 2020. Please note exceptions below.</p> 5786</li><li><p>Extensions are for a duration of 180 days from the original expiration date. The number of approved visits did not change.</p> 5787</li><li><p>Extensions apply to active duty and non-active duty beneficiaries.</p> 5788</li></ul> 5789<p>Note: TRICARE eligibility guidelines still apply. As some beneficiariesâ enrollment status may change during the pandemic shutdown, it is important to verify eligibility and benefit coverage prior to rendering services. Any authorization extensions issued do not supersede TRICAREâs eligibility policies.</p> 5790<p>Extension exclusions</p> 5791<p>The following outpatient care types are excluded from the 180-day extension:</p> 5792<ul><li><p>Active duty Supplemental HealthCare Program (SHCP) waivers</p> 5793</li><li><p>Audiology / Hearing aids</p> 5794</li><li><p>Autism Care Demonstration (ACD)</p> 5795</li><li><p>Mental healthcare</p> 5796</li><li><p>Department of Veterans Affairs (DVA)/Department of Defense (DoD) Memorandum of Agreement (MOA)</p> 5797</li><li><p>Durable Medical Equipment (DME)</p> 5798</li><li><p>Hemodialysis</p> 5799</li><li><p>Home healthcare</p> 5800</li><li><p>Infusions</p> 5801</li><li><p>Line of Duty (LOD)</p> 5802</li><li><p>Maternity-related services</p> 5803</li><li><p>Orthotics/Prosthetics</p> 5804</li><li><p>Stem cell transplant</p> 5805</li></ul> 5806<p> <br /> 5807</p> 5808<p>TRICARE coverage of Transcutaneous Electrical Nerve Stimulation (TENS) and Dry Needling (DN) has changed</p> 5809<p>Effective June 1, 2020, TENS units, and the supplies to support the device, will no longer be covered for acute, subacute and chronic Low Back Pain (LBP).</p> 5810<p>In addition to the device, the following also will not be covered related to a TENS unit:</p> 5811<ul><li><p>Physical therapy visits, where the sole treatment provided is TENS for LBP, will not be eligible for cost-share</p> 5812</li><li><p>Charges for TENS treatment, performed during an otherwise-covered physical therapy visit, will not be eligible for cost-share</p> 5813</li></ul> 5814<p><a href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2024-12-30/AsOf/TP15/C7TOC.html" target="_blank" data-ispdf="false" data-iscta="false" rel="noopener noreferrer">See TRICARE Policy Manual Chapter 7, 4.17</a></p> 5815<p>Dry Needling (DN) is considered unproven by TRICARE and is therefore not a covered service.</p> 5816<ul><li><p>If DN is performed during the course of an otherwise-covered physical therapy visit, TRICARE may cost-share the cost of the covered services, but no reimbursement will be allowed for DN</p> 5817</li><li><p>Physical therapy visits, where the sole treatment is DN, are non-covered</p> 5818</li></ul> 5819<p><a href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2024-12-30/AsOf/TP15/C7TOC.html" target="_blank" data-ispdf="false" data-iscta="false" rel="noopener noreferrer">See TRICARE Policy Manual Chapter 7, 4.18</a></p> 5820<p> <br /> 5821 </p> 5822<p> </p> 5823<p><b>TRICARE is announcing an exception to policy regarding the use of Virtual Health (VH) capabilities for Applied Behavior Analysis (ABA)</b></p> 5824<p>March 31, 2020</p> 5825<p>Attention ABA providers:</p> 5826<p>TRICARE is announcing an exception to policy regarding the use of Virtual Health (VH) capabilities for Applied Behavior Analysis (ABA) services specifically during this COVID-19 pandemic.<
5826/p> 5827<p>During effective dates of March 31, 2020 through May 31, 2020, (âemergency periodâ), TRICARE is permitting the unlimited use of only CPT code 97156 Parent/ Caregiver Guidance when synchronous virtual health services are used for beneficiaries with a current active authorization. DHA will provide additional guidance should the emergency period extend past May 31, 2020.</p> 5828<ul><li><p>CPT code 97156, in person or via TH, may be rendered by only Board Certified Behavior Analysts and assistant behavior analysts.</p> 5829</li></ul> 5830<ul><li><p>CPT Codes 97151, 97153, and 97155 continue to be prohibited for delivery via TH.</p> 5831</li><li><p>The contractor shall remove the Medically Unlikely Edit (MUE) only for CPT code 97156 when it is done via TH to allow for the temporary provision of rendering unlimited CPT code 97156 via TH.</p> 5832</li><li><p>On any date of service, if the GT modifier is used for CPT code 97156, only 97151 and T1023 shall be payable in addition to 97156/GT. All other CPT codes filed on the same date of services as CPT code 97156/GT shall be denied reimbursement.</p> 5833</li><li><p>On any date of services where CPT code 97156 is filed without the GT modifier, all CPT codes in the existing ABA authorization for that beneficiary shall be payable.</p> 5834</li><li><p>No additional authorization is required, and no changes to the existing authorization, including expiration dates, will be required of the contractors. Maintaining the current authorization ensures that all submitted claims are tied to an existing authorization, therefore preventing any non-authorized Autism Care Demonstration (ACD) claims from being paid.</p> 5835</li><li><p>For new authorizations resulting from new referrals during this unique period, CPT code 97151 will be issued to complete an indirect assessment, review of records and development of a treatment. The treatment plan should be developed with the full recommendation of all CPT codes for the six-month authorization period. Any program modifications may be completed under in-person CPT code 97155 once the social distancing provision is lifted.</p> 5836</li><li><p>Should the ABA provider render CPT code 97156 via TH, the claims filed must include the GT modifier and Place of Service code 02 or the claim shall be denied.</p> 5837</li><li><p>Every session rendered via 97156 TH shall adhere to the same documentation standards set forth in TOM Chapter 18, Section 4, Paragraph 17.2. to include documenting Place of Services 02.</p> 5838</li><li><p>All other criteria defined in TPM Chapter 7, Section 22.1 âVirtual Health â apply including the use of a HIPAA compliant platform, and compliance with all state/country licensing and privileging practice laws.</p> 5839</li><li><p>For authorizations that expire during this specified window, the ABA provider may submit CPT code 97151 since much of that time is used for completing the treatment plan update via indirect services. All requirements of CPT code 97151 still apply.</p> 5840</li><li><p>No extensions to the authorization timeline will be granted. For authorizations expiring during this period, and subsequent authorization requests, all relevant requirements (i.e., the PDDBI) are expected to be completed on time.</p> 5841</li><li><p>No retro-authorizations or extensions to the timeline will be authorized.</p> 5842</li><li><p>No other ACD program requirements will be exempt.</p> 5843</li></ul> 5844<p>Additionally, providers should anticipate longer processing and payment times for claims as this policy exception is being implemented.</p> 5845<p>The implementation date for this change is March 31, 2020 and the effective date is March 31, 2020.</p> 5846<p> <br /> 5847 </p> 5848<p> </p> 5849<p><b>Elective procedures in military hospitals/clinics (MTF) and Dental Treatment Facilities (DTF)</b></p> 5850<p>March 30, 2020</p> 5851<p>The Department of Defense (DOD) is directing all military hospitals/clinics and DTFs to immediately postpone all elective surgeries, invasive procedures, and dental procedures performed on beneficiaries with the exceptions outlined below. This includes aerosol-producing procedures, such as endoscopies, bronchoscopies, pulmonary function tests, and sleep Continuous Positive Airway Pressure (CPAP) titrations.</p> 5852<p>This policy is effective March 31, 2020, and will remain in place for 60 days. This action aligns with actions across the nation to conserve vital healthcare resources during this public health emergency, to include bed space, personal protective equipment, supplies and medical personnel. This policy also protects patients, medical personnel and the community from further exposure and transmission of COVID-19.</p> 5853<p>The Commanders and Directors of these facilities may authorize surgeries or procedures that can be safely performed at their facility if required to maintain deployability and readiness of Active Duty Service Members (ADSM) including any Re
5853serve component or National Guard member activated or issued a delayed-effective-date active duty order, as provided in 10 U.S.C. 1074(d). The Commanders and Directors may authorize an elective surgery or procedure if, after consulting with the relevant medical or dental specialist, he or she determines the risk to the patient of delaying the surgery or procedure outweighs safety concerns and logistics considerations (e.g. availability of beds, supplies, equipment and medical providers). Any beneficiary whose procedure is cancelled will be contacted through a means that confirms receipt and, to the greatest extent possible, by personal phone call.</p> 5854<p>As the Military Health System (MHS) prepares for a surge in demand for healthcare services related to COVID-19, it is essential that we take prompt action, informed by local conditions and your risk-benefit analysis. As you take action, we ask that you be mindful of the impact that cancelling or postponing surgery has on our beneficiaries, their families and our professional staff. While their surgeries may be elective, this is nonetheless a meaningful change to their life plans.</p> 5855<p> <br /> 5856 </p> 5857<p> </p> 5858<p><b>Coronavirus Disease (COVID-19) and TRICAREâs virtual health benefit</b></p> 5859<p>April 29, 2020</p> 5860<p>**Update: Effective April 23, 2020, TRICARE has approved use of virtual health services to include otherwise-covered mental health services during the COVID-19 outbreak.</p> 5861<p>These services include:</p> 5862<ul><li><p>Telemental health services, including individual psychotherapy, crisis management, family therapy or group therapy (expected to continue after the coronavirus pandemic)</p> 5863</li><li><p>Medication assisted treatment (only during the coronavirus pandemic)</p> 5864</li><li><p>Opioid treatment programs (only during the coronavirus pandemic)</p> 5865</li><li><p>Intensive outpatient programs, including medication management, case management, recreational therapy, occupational therapy and discharge planning (only during the coronavirus pandemic)</p> 5866</li><li><p>Please note: Full-day (any services lasting six hours or longer), full-intensity PHP services provided under virtual health are not currently covered</p> 5867</li></ul> 5868<p>We are working diligently to update our claims system to reflect this change.</p> 5869<p> <br /> 5870 </p> 5871<p>March 18, 2020</p> 5872<p>**Update: If a beneficiary meets all other criteria for a covered service for speech therapy and for continuation of PT/OT, (but not initiation of PT/OT), it is covered using virtual health, using any coding modifiers as you would for a TRICARE network provider office visit.</p> 5873<p> <br /> 5874 </p> 5875<p>March 17, 2020</p> 5876<p>The CDC, Department of Defense (DOD) and other government partners are closely monitoring the COVID-19 outbreak while encouraging actions to limit the spread of the virus. Utilizing the virtual health option is a safe way to treat patients, while containing the spread to medical facilities.</p> 5877<p>TRICARE covers the use of interactive audio/video technology services, and are subject to the same referral and authorization requirements and include, but are not limited to: clinical consultations, office visits and telemental health.</p> 5878<p>As a reminder:</p> 5879<ul><li><p>For TRICARE payment to be authorized, the provider must be TRICARE-authorized and the service must be within a providerâs scope of practice under all applicable state(s) law(s) in which services are provided and or received.</p> 5880</li><li><p>Video conferencing platforms used for virtual health services must have the appropriate verification, confidentiality and security parameters necessary to meet the requirements of the Health Insurance Portability and Accountability Act (HIPAA).</p> 5881</li></ul> 5882<p>Providers billing for virtual health services that are:</p> 5883<ul><li><p>Synchronous* will use CPT or HCPCS codes with a GT modifier for distant site and Q3014 for an applicable originating site to distinguish virtual health services. Also, Place of Service âPOS 02â is to be reported in conjunction with the GT modifier.</p> 5884</li><li><p>Asynchronous* will use CPT or HCPCS codes with a GQ modifier.</p> 5885</li></ul> 5886<p>*Synchronous virtual health services involve an interactive, electronic information exchange in at least two directions in the same time. Asynchronous virtual health services involve storing, forwarding and transmitting medical information on virtual health encounters in one direction at a time.</p> 5887<p>Applied Behavior Analysis (ABA) providers:</p> 5888<ul><li><p>The TRICARE Operations Manual, Autism Care Demonstration (ACD) specifies that with the exception of completing outcome measures, the ACD does not permit for virtual health (paragraph 8.2.2). Virtual health is not covered for ABA services billed under CPT codes 97151, 97153, 97155 or 97156.</p> 5889</li></ul> 5890<p>When submitting claims for virtual health services, the provider may indicate "Signature not required â distance virtual health site" in the required patient signature field. ABA providers submitting claims for outcome measures administered via virtual health must include the modifier GT.</p> 5891<p>Visit <a data-ispdf="false" data-iscta="false" href="https://manuals.health.mil/pages/DisplayManualHtmlFile/2021-03-26/AsOf/tp15/c7s22_1.html" target="_blank" rel="noopener noreferrer">TRICARE Policy Manual, Chapter 7, Section 22.1</a> for more information.</p> 5892<p> <br /> 5893 </p> 5894<p> </p> 5895<p><b>Breast milk bag modifier has changed</b></p> 5896<p>March 9, 2020</p> 5897<p>On January 1, 2020, Centers for Medicare and Medicaid Services (CMS) released a new Healthcare Common Procedure Coding System (HCPCS) code for use on breast milk storage.</p> 5898<ul><li><p>Providers should use HCPCS code: K1005 for breast milk bag claims filed beginning on 1/1/2020.</p> 5899</li></ul> 5900<ul><li><p>Providers should use HCPCS codes: A9900 or A9999 using modifier âXH for breast milk bag claims filed prior to 1/1/2020.</p> 5901</li></ul> 5902<p>If providers do not bill to the updated HCPCS code K1005 for claims after 3/1/2020, the claims will reject.</p> 5903<p>As a reminder, TRICARE allows 90 breast milk bags, every 30 days following a birth event. Providers must bill for the actual number of milk bags supplied (90), and not for a single (one) box of breast milk bags to get paid correctly.</p> 5904<p> <br /> 5905 </p> 5906<p> </p> 5907<p><b>Home Health Agency (HHA) code update</b></p> 5908<p>March 9, 2020</p> 5909<p>In 2016, a new purchasing demonstration for Home Health Agencies (HHA) was introduced in five East Region states: Florida, Maryland, Massachusetts, North Carolina and Tennessee. The Home Health Value-Based Purchasing Model (HHVBP) offers incentives to any HHAs who give higher quality and more efficient care. The Defense Health Agency (DHA) is currently working on a new HHVBP Demonstration and a Patient-Driven Groupings Model (PDGM).</p> 5910<p>While the new codes are available for use, the new reimbursement information has not been released. To prevent providers from having to resubmit, we are holding claims until DHA updates the information.</p> 5911<p>If providers use the old code, the system will generate an error and claims will not process. If the new code is used, we will hold these claims until DHA releases the new pricing.</p> 5912<p>For more information, visit <a href="https://www.federalregister.gov/documents/2019/09/25/2019-20815/tricare-civilian-
5912health-and-medical-program-of-the-uniformed-services-champus-adoption-of-medicares">HHVBP Adjustments</a> and review the <a href="https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/Other-VBPs/HHVBP">CMSâ FAQs</a></p> 5913<p>Â <br /> 5914Â </p> 5915<p>Â </p> 5916<ul><li><p>February 2, 2020Â Â |Â Â <a href="https://www.cdc.gov/han/php/about/?CDC_AAref_Val=https://www.cdc.gov/han/index.html" target="_blank" data-ispdf="false" data-iscta="false" rel="noopener noreferrer">Get the latest updates on the coronavirus here</a></p> 5917</li></ul> 5918<p>Learn more about and receive guidance on the emerging, rapidly evolving COVID-19 situation...</p> 5919<p>Â </p> 5920<p>Â </p> 5921 5922 </div> 5923 <div class="mi-article-cards__content-cta-wrap"> 5924 <div slot="cta"> 5925 5926 5927 5928 </div> 5929 </div> 5930</div></div> 5931 5932 5933 </div> 5934 5935</div> 5936 5937 5938</div> 5939 5940 </div> 5941 5942 5943</div> 5944 5945 5946</div> 5947 5948 </div> 5949 5950 5951</div> 5952 5953 5954</div> 5955 5956 </div> 5957 5958 5959</div> 5960 5961 5962 <div class="root"> 5963 5964 5965 5966 5967 5968 5969 5970 5971 5972 5973 <div id="container-48aee8a097" class="cmp-container"> 5974 5975 5976 5977<div class="aem-Grid aem-Grid--12 aem-Grid--default--12 "> 5978 5979 <div class="container responsivegrid aem-GridColumn aem-GridColumn--default--12"> 5980 5981 5982 5983 5984 <div id="container-700b7a7f34" class="cmp-container"> 5985 5986 <div class="cmp-cp-footer"> 5987 5988 5989 5990 <nucleus-footer :hide-logo="true" :error="'ignore'" id="nucleus-footer-690fd01a82" data-vue-app="true" :legal-links="[{"href":"/content/humana-military-com/us/en/about.html","target":"_parent","text":"About","enableCookie":"false","attributes":{"rel":"external"}},{"href":"/content/humana-military-com/us/en/contact.html","target":"_parent","text":"Contact","enableCookie":"false","attributes":{"rel":"external"}},{"href":"https://www.humana.com/about/careers","target":"_blank","text":"Careers","enableCookie":"false","attributes":{"rel":"external"}},{"href":"/content/humana-military-com/us/en/about/fraudandabuse.html","target":"_parent","text":"Fraud and Abuse","enableCookie":"false","attributes":{"rel":"external"}},{"href":"https://www.humana.com/about/news","target":"_blank","text":"News","enableCookie":"false","attributes":{"rel":"external"}},{"href":"/content/humana-military-com/us/en/about/internetprivacy.html","target":"_parent","text":"Privacy Policy","enableCookie":"false","attributes":{"rel":"external"}},{"href":"/content/humana-military-com/us/en/about/privacy.html","target":"_parent","text":"Privacy Practices","enableCookie":"false","attributes":{"rel":"external"}},{"href":"/content/humana-military-com/us/en/about/terms.html","target":"_parent","text":"Terms of Use","enableCookie":"false","attributes":{"rel":"external"}},{"href":"/content/humana-military-com/us/en/about.html#urac","target":"_parent","text":"URAC","enableCookie":"false","attributes":{"rel":"external"}}]" :language="{ text:'', href:'' }" back-to-top-id="Top"/> 5991 5992 5993 5994<template v-slot:disclaimer> 5995 5996</template> 5997 5998<template v-slot:copyright> 5999 6000 6001 6002 6003 6004 6005 6006 <!-- Copyright line goes here --> 6007 6008 <!-- Nucleus Icon Starts --> 6009 6010 6011 <div class="footer-icon-copyright"> 6012 6013 6014 6015 6016 6017 6018 6019 6020 6021 6022 6023 <a target="_blank" href="https://facebook.com/humanamilitary" class="footer-social-icon-link nu-text-secondary--nt nu-font-normal nu-p-1 nu-d-inline-block nc-link nb-link--text">
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