Provider Handbook - Avoiding Collection Activities

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Avoiding Collection Activities

Both network and non-network providers are encouraged to explore every possible means to resolve claims issues without involving debt collection agencies. Before sending a beneficiary’s claim to a collection agency, you should do one or more of the following:

Submit an administrative review request.
Request an adjustment on an allowable charge review.
Contact Humana Military at 1-800-444-5445 to verify the status of a claim.

Please wait at least 45 days after submitting a claim before contacting Humana Military. If the problem is still not resolved, providers should contact their local network representative and non-network providers should contact PGBA at 1-800-403-3950 for assistance.

Beneficiaries are responsible for their out-of-pocket expenses. A beneficiary should not be sent to collections before the non-network provider contacts his or her local network representative, unless the only amount outstanding is the beneficiary’s deductible, cost-share, or copayment amount reflected on the Provider Remittance Advice.

TRICARE's Debt Collection Assistance Officer Program

Debt Collection Assistance Officers (DCAOs) are located at each TRICARE Regional Office and MTF to assist TRICARE beneficiaries in determining the validity of collection agent claims and/or negative credit reports received for debts incurred as a result of receiving health care* under the TRICARE program. DCAOs will take all measures necessary to resolve the issues presented.

Beneficiaries must bring or submit documentation associated with a collection action or adverse credit rating to the DCAO. This includes debt collection letters, TRICARE EOBs, and health care bills from providers. The more information the beneficiary provides, the less time it will take to determine the cause of the problem. The DCAO will research the beneficiary’s claim with the appropriate claims processor or other agency points of contact and provide the beneficiary with a written resolution to the collection problem. The collection agency will be notified by the DCAO that action is being taken to resolve the issue.

DCAOs cannot provide beneficiaries with legal advice or fix their credit rating, but DCAOs can help the beneficiary through the debt collection process by providing documentation for the collection or credit-reporting agency in explaining the circumstances relating to the debt.

The DCAO directory is available online.

*"Health care" includes medical and adjunctive dental care under TRICARE.

Last Update: August 26, 2009