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Consult Reports Are Required within 10 Working Days
(Article 10)
 

Consult reports are required to be returned to the primary care manager (PCM) or initiating provider within 10 working days of the patient encounter. For routine specialty referrals for initial office visits, all outpatient services and inpatient services, you must provide complete and legible documentation for these reports to be accurate and useful.

Returning consult reports, op reports and discharge summaries to the initiating provider is important for timely follow up and continuity of care. Please be responsive to the request when asked to return a consult report for TRICARE beneficiaries.

Providers who treat TRICARE beneficiaries coming from the local military treatment facility (MTF) may receive a faxed reminder to return a consult report for a recent visit/service. Your office should return the consult report, op report or discharge summary requested and use the designated fax reminder as the cover sheet. Please use the fax number listed in the upper right corner of the reminder page. This fax number is shown only on the reminder fax to providers for each beneficiary consult return request. This is to avoid having providers send documentation on all other TRICARE beneficiaries.


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Electronic Claims Filing Assistance (Article 11)

TRICARE requires all network providers to file claims electronically.

For assistance with any issues related to electronic media claims (EMC) submission for the TRICARE South Region, you can contact the PGBA EMC Help Desk at 1-800-325-5920, option 2.

You may also visit the Electronic Claims Filing Section of the Provider Handbook or the MyTricare Web site for more information regarding electronic claims submission.


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Fast Referrals and Authorizations (Article 12)  

Take just a few minutes to become a registered user of the Online Provider Services on the Humana Military Web site. Click on the “Sign Up” link on the right-hand side of the Online Provider Services page to get started. Within just a few minutes, you’ll be ready to set-up new referrals and authorizations, check on existing referrals and authorizations, and quickly locate specialists and hospitals that meet your referral needs—all online and with the ease that electronic secure access to vital information offers. You, your staff and your patients will be glad when you become a registered user of Online Provider Services.

 


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Last Reviewed:  February 13, 2007