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During a high-deployment time, three out of four primary care managers (PCMs) at Southern Command Clinic, a military treatment facility (MTF) in Florida, were activated for overseas duty. Their 1,700 patients were given only two weeks notice that they would have to transfer to civilian PCMs.

Situations like these arise from time to time, necessitating a change in PCM for beneficiaries, but this one was unusual for its high numbers and quick termination.

For Nancy Eberhard, TRICARE Service Center manager for Southern Florida, it was a call to action. Whenever MTFs have this type of need, usually from a loss of one or more of their PCMs, they either work with the local TRICARE Service Center or contact Humana Military directly to help coordinate the change.

First, Nancy determined where most of the affected beneficiaries lived, and then she and her team alerted the more than 100 civilian PCMs in the area of the situation. They made countless calls, as well as site visits, to physician offices.

When Nancy learned of a military spouse’s expo, she took advantage of the good timing and volunteered to be a speaker, where she informed affected beneficiaries about what to expect and how to avoid any delay in medical care. She also worked with Humana Military’s upper-level staff in Louisville, Ky., along with the billing and enrollment departments, to ensure a smooth transition.

Due to quick action and concentrated efforts, all but five beneficiaries successfully selected a new PCM within the two-week time frame. The remaining five transitioned a day or two later.

There are a number of reasons why you may be asked to change your PCM:
 

• A change in policy by the Services
• A troop realignment that brings a large number of active duty and their families into an area, creating the need to move retirees out to the TRICARE provider network to accommodate active duty at the MTF
• Closing or realignment of clinics or facilities
• Delays in getting replacement PCMs (which has occurred during PCS season)

Typically, MTFs issue a letter 60 days in advance to each impacted beneficiary explaining why the change has to occur. If you do not choose a new PCM by the date specified in the letter, one will be assigned for you.

If you have questions about changing your PCM, call Humana Military at 1-800-444-5445.

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1. Make sure your DEERS information is correct and current.  Call 1-800-538-9552 to update DEERS.
    
2. Provide complete and accurate information to your provider, including your sponsor’s SSN, your current home address and phone number, and any other pertinent information.
    
3. TRICARE Prime beneficiaries usually use network providers who file claims on behalf of the beneficiary. If you use a non-network provider or require emergent/urgent care outside the South Region, the provider may require you to pay out of pocket and file your own paper claim for reimbursement.
    
4. Beneficiaries filing claims on their own behalf should use a DD Form 2642, available online on the TRICARE Web site, as well as at any military treatment facility or TRICARE Service Center.
    
5. Your completed claim form should contain relevant dates, procedures, costs and diagnoses. Diagnosis codes, which can be obtained from your provider, are required on all claim forms submitted to TRICARE.
    
6. The DD Form 2642 also must include the patient’s (or parent’s/guardian’s) signature or the claim will be denied.
    
7. Attach the itemized bill from your physician to the claim form. The bill must contain the provider’s billing letterhead.
    
8. If you have been hurt in an accident and a third party is responsible, inform TRICARE. Complete a DD Form 2527 and submit it with your DD Form 2642 claim form.
    
9. Send your claim forms to the correct address to avoid processing delays:
    
   TRICARE South Region
   Claims Department
   P.O. Box 7031
   Camden SC 29020-7031
    
10. Keep copies of everything you submit so that you have records in the event you need to appeal a claim denial.

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Last Reviewed:  December 4, 2007