Humana Military Healthcare Services TRICARE Provider News

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Get Up-to-Date Provider Information on the Web or Over the Phone (Article 3)

As a primary care manager (PCM) for TRICARE beneficiaries, there may be instances where you will need to refer your patients to providers, facilities or specialists for continuity of care. Accessing accurate and real-time TRICARE South Region provider information is no farther than a click or call away thanks to Humana Military Healthcare Services, Inc. Humana Military’s Provider Locator tools are easy to use and available anytime—24 hours a day, seven days a week— or via 1-800-444-5445.

In order for Humana Military’s Provider Locator tools to continue to provide accurate and up-to-date information, providers must be vigilant about updating the system when there are changes in their demographic information. To update your provider information, simply visit Online Provider Services.

Resolving Claims Errors: Work within the TRICARE System (Article 4)

A simple claim error can lead to a complicated and stressful situation for you, your staff and the TRICARE beneficiary involved. Such situations are further complicated when debt collection agencies become involved. When a claims problem occurs, you’ll often see quicker results if you work directly within the TRICARE system by collaborating with your regional contractor, claims processor and beneficiary advocates.

Both network and non-network providers are encouraged to explore every possible means to resolve claims issues without nvolving debt collection agencies. In the TRICARE South Region, Humana Military Healthcare Services’ claims processor partner, PGBA, LLC (PGBA), is your first point of contact for resolving claims issues. In most instances, PGBA will be ble to resolve your issue or concern. Call PGBA at 1-800-403-3950 or visit the PGBA Web site.

If the problem cannot be resolved at this level, encourage your patients to contact a TRICARE beneficiary advocate. Beneficiary counseling and assistance coordinators (BCACs) and debt collection assistance officers (DCAOs) can help the beneficiary better understand their benefit and help them understand and resolve claims issues. DCAOs, in particular, help beneficiaries evaluate the validity of collection agency claims and/or the negative credit reports that sometimes result from them. Sometimes, when acting as the beneficiary advocate, the DCAO may even contact you. Any information you can provide to expedite resolution is greatly appreciated. BCACs and DCAOs are located at TRICARE Regional Offices and at military treatment facilities (MTFs). To find a BCAC or DCAO near you, call the closest MTF or search the online BCAC/DCAO Directory .

Common Claims Errors

To help avoid claim errors, double-check the accuracy of the following before submitting a claim:

Correct beneficiary address
Correct Social Security number (SSN)—Do not submit under the beneficiary’s SSN unless that person is the military “sponsor” or the person is an eligible former spouse.
Correct procedure and diagnosis codes—Unclassified Current Procedural Terminology (CPT) or Healthcare Common Procedure Coding System (HCPCS) codes should be used only with a clear description of what is being billed.

Created: March 3, 2008