With just a couple of clicks on Humana Military’s Web site, you can speed your patients’ referrals to specialists and cut down your—and your office staff’s—workload.

An online referral or authorization can be accomplished in as little as five minutes, compared with potentially lengthier telephone and fax referral wait times. One of the reasons more than 50 percent of providers use the online referral system is its efficiency—it automatically populates much of the needed referral information.

Because of this, the majority of your online referrals and authorizations are approved on the spot and completed while your patient is still in the office.

You can access the online referral and authorization section by visiting “Online Provider Services” and then selecting the “Online Referrals and Authorizations” link. Just remember, you must sign in to use this feature.

In addition to shortening the initial referral and authorization process, the online system offers several other advantages: It lets you check the status of an existing referral or authorization, search for specialists and look up diagnosis and procedure codes.

The status of claims submitted for your Provider ID can be checked at any time, 24 hours a day. Claim summary information for all requested claim types is returned on one report. You can specify a single TRICARE sponsor, claim type, or the time period and the order in which the claims will be returned.

If you haven’t already done so, you can become a registered user of the Humana Military Web site by clicking the “Sign Up” link on the right-hand side of the Online Provider Services page and following the prompts given by the “User Sign up Wizard.” Please keep in mind that only network providers have access to the Referral/Authorization screens.

  
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A recent change in TRICARE policy now allows you to more accurately file claims for the home infusion medications you prescribe to your patients.

The new procedure requires you to include the National Drug Code (NDC) number in addition to the J-code when filing claims for home infusion medications. The J-code, from the Level II Healthcare Common Procedure Coding System (HCPCS), specifies the name and the dose of the prescribed injectable drug.

The new policy went into effect July 1, 2006, but is retroactive for claims filed since April 1, 2005, which allows you to re-file claims from that date on and may result in a larger payment.

“Providers will now put the J-code on the form and, in the same block, they would have put the NDC number. That’s the new part,” said Miller Brown, a systems engineer in Humana Military’s Claims Oversight Department.

“Because there are a lot of different manufacturers, and they have their own prices, with the NDC number it tells specifically what drug is being prescribed and the units associated with that number,” Brown said.

Home infusion medications include:  antibiotics for post-op infections or osteomylitis, etc.; Cerezyme for Gaucher Disease; Flolan for patients awaiting lung transplants; and Factor VIII for hemophilia.

If you’re one of the many providers enjoying the benefits of electronic claims filing, the following instructions give you the loops or segments where you should send J-codes and NDC numbers in the HIPAA-standard ASC X12 837 electronic claims format:
 

• 2400/SV101 = J code
   
• 2400/SV103 = “UN” (unit) for Package, or “F2” (International unit) for Unit
   
• 2410/LIN03 = NDC#  (11 digits with no dashes or spaces)
   

• Make sure the NDC number is listed above the J-Code on the CMS-1500.
   
• Enter the NDC number without using spaces or dashes.
   
• Some NDC numbers have a package or unit price, so make sure to put a “P” or a “U” after the NDC number, if necessary.
   

“The most confusing thing for providers is in the ‘units’ box on the CMS-1500. They will now put the units that refer to the NDC number instead of the units that refer to the J-code,” Brown said.

To ensure your claims are paid promptly, make sure to include the NDC number if the place of service is “home,” or the claim will be denied. If your claim is denied for this reason, it can be resubmitted, but payment will be delayed.

  
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Updated: March 3, 2008