|
Provider Handbook
|
| |
Previous Page Table of Contents Next Page
|
|
|
|
Supplemental Health Care Program
Civilian Care
Referrals and Authorizations
Provider Responsibilities
Other Health Insurance and Third-Party Liability |
|
Supplemental Health Care Program |
|
TRICARE is derived from the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS), which technically does not cover ADSMs (or National Guard/Reserve members on active duty). However, similar to TRICARE, the Supplemental Health Care Program (SHCP) provides coverage for ADSMs (except those enrolled in TPR) and non-active duty individuals under treatment for line-of-duty conditions. While the SHCP is also funded by the DoD, it is separate from TRICARE and follows different rules.Only the following individuals are eligible for the SHCP:
|
|
- ADSMs assigned to an MTF
- ADSMs on travel status (e.g., leave, temporary assignment to duty, or permanent change of station)
- Navy or Marine Corps service members enrolled to deployable units and referred by the unit PCM or other provider who is not an MTF PCM
- National Guard/Reserve members on active duty
- National Guard members ( ( LOD care only, unless beneficiary is on active federal service)
- National Oceanic and Atmospheric Administration personnel, U.S. Public Health Service personnel, cadets or midshipmen, and eligible foreign military personnel
- Non-active duty beneficiaries—when an inpatient in an MTF and referred to a civilian facility for a test or procedure unavailable in the MTF, provided the MTF maintains continuity of care over the inpatient and the beneficiary is not discharged from the MTF prior to the procedure
- Comprehensive Clinical Evaluation Program participants
|
|
To verify patient eligibility for the SHCP, call Humana Military at 1-877-249-9179. |
|
Back to Top
|
|
Civilian Care |
|
When SHCP individuals need services that are not available at the MTF, the MTF physician issues a referral to a civilian provider. Care referred or authorized by the MTF and/or the MMSO will be covered under the SHCP. SHCP individuals are not responsible for deductibles, cost-shares, or copayments.
|
|
Back to Top
|
|
Referrals and Authorizations |
|
The MTF (if one is available) or the MMSO will initiate referrals for ADSMs and other designated patients to civilian specialists and sub-specialists for services that are beyond the scope of primary care. If it is determined that services are unavailable at the MTF, a DD Form 2161 (this form may vary by MTF site) will be completed and sent to Humana Military prior to sending the patient for specialty care. Humana Military and the MTF, as appropriate, will agree on a civilian provider to administer the care and will notify the patient. For non-MTF referred care, the SPOC will determine if the ADSM will receive care from an MTF or civilian provider.
|
|
Back to Top
|
|
Provider Responsibilities |
|
Network providers are required to adhere to all contract requirements when treating SHCP individuals, including office and appointment access standards. Refer to the Important Provider Information section for more information about provider responsibilities. |
|
Back to Top
|
|
Other Health Insurance and Third-Party Liability |
|
Humana Military will not apply other health insurance or third-party liability processing procedures to SHCP claims for outpatient active duty and non-TRICARE-eligible beneficiaries. These procedures will also not apply to all SHCP inpatient claims.
See the Claims Processing and Billing Information section for SHCP claims submission information.
For more information regarding SHCP call 1-877-249-9179.
|
|
Back to Top
|
|
|
