Provider Handbook - Provider Responsibilities

Home » Provider » Tools & Resources » Handbook & Materials » Handbook ToC » Provider Information » Provider Responsibilities

Provider Information Policy Resources SSN Reduction Plan HIPAA Overview HIPAA Privacy HIPAA Rules Signature on File Requirements TRICARE Provider Types Certification & Credentialing Provider Responsibilities PCM Role Specialty Care Balance Billing Non-Covered Services Updating Provider Information Beneficiary Expectations

Adjust Text Size:

Provider Responsibilities

Network providers sign contracts with Humana Military to comply with all TRICARE and Humana Military regulations. This handbook is not all-inclusive and only provides an overview of TRICARE policies and procedures. Visit the Provider portal for more information about provider responsibilities and contract requirements.

Non-Discrimination Policy

All TRICARE-authorized providers agree not to discriminate against any TRICARE beneficiary on the basis of his or her race, color, national origin, or any other bases recognized in applicable laws or regulations. To access the full TRICARE policy, refer to the TRICARE Operations Manual, Chapter 1, Section 5.

Office and Appointment Access Standards

TRICARE access standards ensure that beneficiaries receive timely care within a reasonable distance from their homes. Emergency services must be available 24 hours a day, seven days a week. Network and MTF providers must adhere to the following access standards for nonemergency care:

Initial behavioral health care appointment with a behavioral health care provider:
- Routine behavioral health care appointment: One week (seven days)
- Urgent behavioral health care appointment: One day (24 hours)
Preventive care appointment: Four weeks (28 days)
Routine care appointment: One week (seven days)
Specialty care appointment: Four weeks (28 days)
Urgent care or acute illness appointment: One day (24 hours)

Office wait times for nonemergency care appointments shall not exceed 30 minutes except when the provider’s normal appointment schedule is interrupted due to an emergency. If you are running behind schedule, notify your patient of the cause and anticipated length of the delay, and offer to reschedule the appointment. The patient may choose to keep the scheduled appointment.

Missed Appointments

TRICARE regulations do not prohibit providers from charging missed appointment fees. TRICARE providers are within their rights to enforce practice standards, as stipulated in clinic policies and procedures, that require beneficiaries to sign agreements to accept financial responsibility for missed appointments. TRICARE does not reimburse beneficiaries for missed appointment fees.

Last Update: January 15, 2011