Shortly after the initiation of the new TRICARE contract, which covers the medical management of active duty members, we received an urgent call from an MTF for assistance with an active duty service member.

The member initially presented to the MTF with bone pain and was admitted to a local civilian facility where cancer was diagnosed. The initial treatment plan was possible disarticulation of the involved limb due to rapid disease progression. A second opinion was sought at a civilian center of excellence.

A case manager was assigned and the member was transferred to a medical facility some 2,000 miles from his primary support structure, his spouse and young children. The case manager quickly became the vital link between the MTF, the civilian facility, the family and the member, thus alleviating much of the anxiety and hardship caused by his illness.

After confirmation of the initial diagnosis, the patient was treated with chemotherapy and an autologous stem cell transplant. Thanks to the sensitivity, compassion and professionalism of the case manager and the rest of the medical team, the member is doing well without the loss of any limbs. In this case, military and civilian providers, facilitated by Humana Military case managers proved to be an awesome team. Our thanks to each of you who help us write terrific stories of caring and healing like this each day. 

Capital and Direct Medical Education Expenses (Article 3)

TRICARE will reimburse hospitals annually for their portion of capital costs which is derived from the allowable capital cost shown on Medicare reports. The capital costs will be reduced in accordance with the statutory reductions for Medicare.

In addition, for approved teaching programs, TRICARE will reimburse hospitals annually for direct medical education (DME) costs, which is derived from the allowable DME cost shown on the Medicare cost reports.

To fully understand the calculation of capital and DME costs, please refer to the TRICARE Reimbursement Manual, Chapter 6, Section 8.

TRICARE will provide reimbursement for capital and direct medical education expenses on an annual basis as long as the provider submits a timely request for such reimbursement and follows the necessary instructions. Such reimbursement is subject to a number of regulations, which are outlined for you in the instructions for the TRICARE Request for Reimbursement of Capital and Direct Medical Education Costs Form.

When completing the form, you must give the total number of inpatient days, which is the number of days provided to all patients in units subject to diagnosis-related group (DRG) based payments. The request must be submitted on or before the last day of the twelfth month following the close of the cost-reporting period, and the request must correspond to the Medicare cost-reporting period. Properly completed requests will be processed in 30 to 45 days. All providers must submit the applicable pages from their Medicare Cost Report. When requesting reimbursement, be sure to use an original signature because copied signatures will not be accepted.

The form requests information on the hospital name and address, the TRICARE provider number, the Medicare provider number, the period covered and total inpatient days. The form also requires the number of inpatient days that were “allowed” for payment, the total allowable capital costs, the number of full-time equivalent residents and interns, and the total number of inpatient beds.

If you have questions about how to complete the form, you can get more information at My TRICARE . You also may contact a Humana Military capital and direct medical education expenses specialist by calling 502-580-3420, faxing to 502-580-9708 or e-mailing to HMHSCapitalDirectMedEd@humana.com. To submit requests or to write to the capital and medical education expenses specialist, please use the following address:

Humana Military Healthcare Services
Attn: Claims Oversight Department—Polly Hall
500 West Main Street
Louisville, KY 40202

Any questions concerning these revisions should be directed to Suzanne Corum at Humana Military at 502-580-2603.

Back to Top