Provider Handbook
    

Previous Page              Table of Contents            Next Page
       
TPR Enrollment Card
TRICARE Standard and TRICARE Extra
           
TPR Enrollment Card
Beneficiaries enrolled in TPR or TPRADFM receive TPR enrollment cards. Network providers may require beneficiaries to show the card at the time of service. These cards are not required to obtain care, but do contain important information for the beneficiary. Figure 4.2 shows an example of the TPR enrollment card.
 
TPR Enrollment Card

Fig. 4.2
Image of TPR Enrollment Card 
           
In addition to their TPR enrollment card, beneficiaries should present their uniformed services ID or CAC at the time of service. Only the uniformed services ID card or CAC may be used to verify eligibility for care. Providers must verify eligibility through the Humana Military Web site or by calling 1-800-444-5445. See the TRICARE Eligibility section for more information about verifying eligibility.
           
TPR/TPRADFM POS Option

The POS option does not apply to TPR ADSMs. If they receive care without a referral or prior authorization, the claim will be forwarded to the SPOC for payment determination. If the SPOC does not approve the care, the ADSM is responsible for the bill. If the SPOC approves the care, the ADSM does not have copayments, cost-shares, or deductibles. However, TPRADFM beneficiaries are subject to the same POS provisions as TRICARE Prime. They must coordinate care with their PCM, or they will be required to pay the higher 50-percent cost-share and a deductible.


Back to Top

TRICARE Standard and TRICARE Extra

TRICARE Standard and TRICARE Extra are available to all TRICARE-eligible beneficiaries except ADSMs. Beneficiaries are responsible for fiscal year deductibles and cost-shares. Beneficiaries may see any TRICARE-authorized provider they choose, and TRICARE will share the cost of covered services with the beneficiaries after deductibles are met.

TRICARE Standard is a fee-for-service option. Beneficiaries may seek care from any TRICARE-authorized provider.

TRICARE Extra is a preferred provider option. Beneficiaries choose a doctor, hospital, or other medical provider within the TRICARE provider network. By choosing a network provider, the beneficiary’s out-of-pocket costs are reduced. For specific inpatient cost-shares, contact Humana Military at 1-800-444-5445 or visit the TRICARE Web site.


Back to Top

 

 

 

 

 

 

 

 
Last Update: July, 2007