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Provider Handbook
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An Important Message from TRICARE
Hold Harmless Policy
Informing Beneficiaries About Non-covered Services
Updating Provider Information |
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“An Important Message from TRICARE” |
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Inpatient facilities are required to provide each TRICARE beneficiary with a copy of the document “An Important Message from TRICARE.” This document details the beneficiary’s rights and obligations upon admission to the hospital. The signed document must be kept in the beneficiary’s file. A new document is needed for each admission. |
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Hold Harmless Policy |
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A provider may not require payment from a TRICARE beneficiary for any excluded or excludable services that the beneficiary received from the network provider (i.e., the beneficiary will be held harmless) except as follows:
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- If the beneficiary did not inform the provider that he or she was a TRICARE beneficiary, the provider may bill the beneficiary for services provided.
- If the beneficiary was informed that the services were excluded or excludable and he or she agreed in advance to pay for the services, the provider may bill the beneficiary.
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Informing Beneficiaries About Non-covered Services |
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TRICARE beneficiaries must be properly informed in advance and in writing of specific services or procedures that are not covered under TRICARE before they are provided. If they choose to be financially responsible for the noncovered services, beneficiaries may sign a waiver agreeing to pay for non-covered services.
However, if the provider does not obtain a legal signed waiver, and the care is not authorized by Humana Military, the provider is expected to accept full financial liability for the cost of the care. In addition, the waiver signed by a beneficiary after the care is rendered is not valid under TRICARE regulations.
For the beneficiary to be considered fully informed, TRICARE regulations require that:
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- The agreement is documented and signed prior to the specific non-covered services being rendered.
- The agreement is in writing.
- The specific treatment, date(s), estimated cost of service, and billed amounts are documented.
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General agreements to pay, such as those signed by the beneficiary at any time of admission, are not evidence that the beneficiary knew specific services were excluded or not allowable.
Providers should maintain copies of the waiver in their office and fully inform beneficiaries in advance when specific services or procedures are not covered. See the Medical Coverage section for a summary of TRICARE-covered and noncovered services and benefits.
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Waivers of Non-covered Services |
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A network provider can utilize the waiver of non-covered services when the beneficiary is properly informed, in advance, that TRICARE does not cover a particular service and he or she agrees in writing to be financially responsible. Access the Waiver of Non-Covered Services forms or copies can be requested from your local Provider Relations Representative. |
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Updating Provider Information |
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It is important for Humana Military to have the most current and accurate data concerning your practice to facilitate timely claims payment and correspondence. Notify Humana Military of any changes in your status, address, phone, or fax numbers by calling 1-800-444-5445. |
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