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On November 11, 1918, peace finally reigned over the battlefields of Europe with the end of the “War to End All Wars.”

Almost 90 years after the guns fell silent at the end of World War I, we observe Veterans Day on this anniversary and celebrate the contributions of those men and women who have served America through the years and around the globe.

Your service to our military family is critical during this time when we have an increasing number of veterans needing health care.

TRICARE and Humana Military want to thank you, our providers, for caring for our active duty service members, National Guard and Reserve members, military retirees and family members throughout the year. And to those of you who are veterans, we extend our gratitude for your dedication and years of service.

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From the Desk of the CMO (Article 2)

John Crum, MD, Chief Medical Officer, Humana Military Healthcare Services, Inc.

Screening colonoscopy once every 10 years is now covered for persons over age 50 at average risk for colorectal cancer. Other covered screening methods in persons over age 50 are fecal occult blood testing annually and sigmoidoscopy every three to five years.

The TRICARE Clinical Preventive Services benefit covers age-appropriate vaccines recommended by the CDC’s Advisory Committee on Immunization Practices (ACIP).

In June, the ACIP recommended quadrivalent human papillomavirus vaccine to be added to the routine vaccination schedule for girls 11 or 12 years of age. This timing is designed to coincide with other routine vaccinations given in that age group. The panel recommended that girls and women ages 13 to 26 should also receive the vaccine.

The Department of Defense requires use of a claims auditing software to ensure correct coding on claims. Humana Military uses software called ClaimCheck® and ClaimReview™ to edit professional and outpatient facility claims prior to payment. This software requires providers to file claims with precise and accurate information.

ClaimCheck is a review system that audits claims for correct coding of CPT and Healthcare Common Procedure Coding System procedure codes. ClaimCheck audits for:
         

• Incidental procedures
• Medical visits billed with primary procedures
• Unbundled services
• Mutually exclusive procedures
• Services included in pre- or post-operative care
• Bilateral and duplicate procedures

• Diagnosis to procedure code consistency
• Intensity of service
• New visit frequency

The South Region provider handbook gives detailed explanations of ClaimCheck and ClaimReview.

The handbook is sent to network and non-network providers every year, and is available on the Humana Military Web site as a searchable PDF file. Local Humana Military Provider Education and Relations Representatives (PERRs) are also available to assist providers.

Remittances carry reason code messages that identify, per claim line, edits resulting from the claims auditing software.

If you don’t understand or agree with a ClaimCheck or ClaimReview reject, please review the claim and associated medical documentation.

If additional or more complete coding is available:
       

• Adjust the coding on the claim
• Mark “corrected claim” on top of claim form
• Submit to PGBA with medical documentation
• If more complete coding is not available, submit a request for reconsideration with supporting documentation to justify the codes applied on the original claim. Direct requests to:
          

• American Health Information Management Association Web site
• American Academy of Professional Coders Web site

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Updated: October 15, 2007