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Prime Remote Handbook
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Filing an Appeal: Active Duty Service Members
Filing an Appeal: Active Duty Family Members |
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Filing an Appeal: Active Duty Service Members |
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Your service point of contact (SPOC) will tell you how to file an appeal, if you think you need one. You or your PCM or provider may send additional written information or documentation to support your request for specialty care to the SPOC. |
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Active Duty Appeals Contact Information |
Figure 7.2
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| Service Branch |
SPOC Contact Information |
| DoD (Army, Air Force, Navy, Marine Corps) |
1-888-MHS-MMSO
(1-888-647-6676)
Written Inquires:
(insert your branch of service)
Point of Contact
Military Medical Support Office
P.O. Box 886999
Great Lakes, IL 60088-6999
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| Coast Guard |
1-888-MHS-MMSO
(1-888-647-6676)
1-800-9HBA-HBA
(1-800-942-2422) |
| NOAA |
1-800-662-2267 |
| USPHS |
1-800-368-2777, option #2 |
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Active duty service members enrolled at an MTF should appeal to the MTF and not to the MMSO SPOC. |
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If your request is denied on appeal, you may appeal one more time to the Surgeon General or senior medical officer of your respective service. The address for this second appeal will be provided to you following a denial of the first appeal. |
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Filing an Appeal: Active Duty Family Members |
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Appeals must be filed with Humana Military within particular deadlines. If you are not satisfied with a decision rendered on an appeal, there are further levels of appeal. For specific information about filing an appeal in the South Region, contact Humana Military.
Prior authorization denial appeals may be either expedited or non-expedited, depending on the urgency of the situation. You or an appointed representative must file an expedited review of a prior authorization denial within three calendar days after receipt of the initial denial. A non-expedited review of a denial must be filed no later than 90 days after receipt of the initial denial.
Appeals should contain the following:
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- Beneficiary’s name, address, and telephone number
- Sponsor’s Social Security number
- Beneficiary’s date of birth
- Beneficiary’s or appealing party’s signature
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A description of the issue or concern must include:
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- The specific issue in dispute
- A copy of the previous denial determination notice
- Any appropriate supporting documents
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Send your appeal to Humana Military. See Figure 7.3 for appeals filing information. |
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Regional Appeals Filing Information for Family Members |
Figure 7.3
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| TRICARE South Region |
Claims Appeals:
TRICARE South Region Appeals
P.O. Box 202002
Florence, SC 29502-2002 |
Prior Authorization Appeals:
Humana Military Healthcare Services
Attn: Clinical Appeals
P.O. Box 740044
Louisville, KY 40201-9973 |
Behavioral Health Appeals:
ValueOptions Behavioral Health
Attn: Appeals and Reconsideration Department
P.O. Box 551138
Jacksonville, FL 32255-1138 |
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