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1.     An Eye on TRICARE Vision Services
2.     Reports Now Due in 10 Working Days
3.     So Many Choices, So Little Time
4.     Humana Military Announces Address Changes for CHCBP Claims
5.     Behavioral Health Services
6.     Contacts


 An Eye on TRICARE Vision Services (Article 1)

Maintaining excellent eye health begins with access to quality eye care providers, such as TRICARE-authorized optometrists or ophthalmologists. As a TRICARE provider, you can help beneficiaries better understand and utilize their TRICARE vision benefits.

  • TRICARE vision services vary depending on beneficiary status (i.e., active duty family member, retired service member, retired family member or survivor) and whether covered by TRICARE Prime, Extra, or Standard. Refer to the chart for coverage specifics (note that TRICARE Prime beneficiaries never have a copayment for routine and clinical preventive eye examinations).
  • TRICARE-authorized optometrists or ophthalmologists must provide all vision care.
  • TRICARE Prime beneficiaries may receive preventive eye examinations from any network provider without referral or authorization from their primary care manager (PCM) or Humana Military. If a preventive eye examination is not available from a network provider, TRICARE beneficiaries can access vision care services from a non-network provider with a PCM referral and an authorization from Humana Military.
  • Contact lenses or eyeglasses are only covered for treatment of infantile glaucoma, Keratoconus, dry eyes when normal tearing is inadequate or absent, irregularities in the shape of the eye other than astigmatism, and loss of human lens function resulting from eye surgery or congenital absence.
  • Active duty service members are covered for eyeglasses at military treatment facilities.
    For more information on vision services, contact Humana Military Healthcare Services through the provider service line at 1-800-444-5445.

Annual Routine Eye Examinations
An evaluation of the eyes not related to a medical or surgical condition;including but not limited
to refractive services. CPT Codes: 92002, 92004, 92012, 92014, 92015, 99172, and 99173.

Beneficiary

Coverage 

TRICARE Prime

TRICARE Extra

TRICARE Standard 

Active duty family members One routine eye examination per year No copayment 15%
cost-share
20% cost-share
Retirees, their
families and others
Not covered for annual exams; however, see Clinical Preventive Examinations for coverage Not covered
See Clinical Preventive Exams
Not covered Not covered

Clinical Preventive Eye Examinations
Comprehensive screening for determination of vision on visual acuity, ocular alignment, and red reflux,
along with external examination for ocular abnormalities.
CPT Codes: 92002, 92004, 92012, 92014, 92015, 99172, and 99173.

Infants* One eye and vision screening
from PCM at birth and 6 months
No copayment 15%
cost-share
20% cost-share
Children*
(ages 3-6)
One comprehensive eye exam from a specialist every 2 years** No copayment 15%
cost-share
20% cost-share
Adults* and children over age 6 One comprehensive eye exam from a specialist every 2 years** No copayment Not covered Not covered
*Includes active duty family members, retirees, their families, and others. Recent retirees and their families enrolled in TRICARE Prime should note that the first preventive eye exam (routine or preventive) is available two years after the last eye exam performed as an active duty service member or active duty family member. The benefit does not start over upon retirement.
**Diabetic patients, at any age, should have comprehensive eye examinations at least yearly.

Reports Now Due in 10 Working Days
(Article 2)
Specialists and hospitals in the South Region now have 10 working days to submit required reports to referring providers.

Humana Military network specialty providers must provide clearly legible, specialty care consultation and operative reports to referring providers within 10 working days of the patient’s date of service. Hospitals and other facilities must also send all discharge summaries or operative reports to referring providers within 10 working days of the patient’s date of service or discharge.

Once primary care managers (PCMs) or other providers initiate a referral or authorization request with Humana Military, a fax confirmation letter of the referral or authorization will be sent to the initiating provider, the specialist involved, and possibly the facility where the service will be performed. This fax confirmation will include information on the beneficiary, the referral or authorization number, and directions that explain when and where to return the consultation and operative report or discharge summary.

The initiating provider should retain the fax confirmation notice in the patient’s file as a reminder to send the report or summary once the beneficiary’s specialist appointment has been scheduled.

The specialist involved is responsible for sending the consult report and any operative reports that may apply. Facilities also may need to ensure that operative reports and/or discharge summaries are returned to the initiating provider.

Urgent/Emergent Situations
In urgent/emergent situations, providers should note that a preliminary report of a specialty consultation shall be conveyed to the beneficiary’s PCM within 24 hours (unless best medical practices dictate less time is required for a preliminary report) by telephone, fax, or other means, and a formal written report shall be provided within the standard 10-day time frame.

Using the Right Fax Number
Humana Military provides a fax number on the referral or authorization confirmation with directions and the time frame for responding with the consult report, operative report or discharge summary.

All providers should make sure that they have programmed their fax machines with the most up-to-date Humana Military fax numbers, and they should ensure that each fax machine is programmed so that the sending fax number is printed on the top of each page that is transmitted.

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