TRICARE Prime Remote and TRICARE Prime Remote
for Active Duty Family Members
TPR and TRICARE Prime Remote for Active Duty Family Members (TPRADFM) provide TRICARE Prime coverage to ADSMs (including activated National Guard and Reserve members) and their families in remote locations through a civilian network of TRICARE-authorized providers, institutions, and suppliers (network or non-network).
ADSMs and their families who live and work more than 50 miles or a one-hour drive time from an MTF designated as adequate to provide primary care may be eligible to enroll in TPR or TPRADFM. To determine if a particular ZIP code falls within a TPR coverage area, use the TRICARE zip code look up tool.
National Guard and Reserve members and their families may be eligible for TPR and TPRADFM in certain circumstances. See the TRICARE Eligibility section of this handbook for instructions on how to verify patient eligibility.
TPR and TPRADFM are offered only in the 50 United States, and both require enrollment with Humana Military for participation within the TRICARE South Region.
Accessing Health Care
Similar to TRICARE Prime, TPR and TPRADFM beneficiaries choose a PCM to provide primary care services and coordinate specialty care. In some cases, however, TPR and TPRADFM beneficiaries may have to choose a non-network TRICARE-authorized provider as their PCM if there are no network providers in their area. These beneficiaries can also receive services from military providers if they are willing to travel to the MTF.
ADSMs can receive primary care services without a referral, prior authorization, or fitness-for-duty review. Specialty and inpatient care will require a referral and prior authorization from Humana Military and the service point of contact (SPOC). The SPOC will determine how to manage the referral if the care is related to fitness for duty.
ADSMs assigned to a civilian PCM require a PCM referral for behavioral health care. ADSMs without an assigned PCM will need to contact ValueOptions at 1-800-700-8646 for behavioral health care. Providers can fax a TRICARE Outpatient Treatment Report form to ValueOptions at 1-866-811-4422 for additional outpatient visits. Clinical information is entered into the authorization system, and this information is electronically forwarded to the Military Medical Support Office (MMSO), which reviews each TPR request for services before an authorization number is given to the PCM or ADSM (for the behavioral health provider).
Family members using TPRADFM may require a referral for specialty care and/or prior authorization for certain services. Contact Humana Military’s Interactive Voice Response (IVR) system at 1-800-444-5445 for more information or assistance.
Figure 4.2 TPR Enrollment Card
TPR Enrollment Card
Beneficiaries enrolled in TPR or TPRADFM receive TPR enrollment cards. Network providers may require beneficiaries to show the card at the time of service. These cards are not required to obtain care, but do contain important information for the beneficiary. Figure 4.2 shows an example of the TPR enrollment card.
In addition to their TPR enrollment card, beneficiaries should present their uniformed services ID card at the time of service. Only the uniformed services ID card may be used to verify eligibility for care. Providers must verify eligibility through the MyHMHS for Providers secure portal or by using the IVR system at 1-800-444-5445. See the TRICARE Eligibility section of this handbook for more information about verifying eligibility.
TPR/TPRADFM POS Option
The POS option does not apply to TPR ADSMs. If they receive care without a referral or prior authorization, the claim will be forwarded to the SPOC for payment determination. If the SPOC does not approve the care, the ADSM is responsible for the bill. If the SPOC approves the care, the ADSM does not have copayments, cost-shares, or deductibles. However, TPRADFM beneficiaries are subject to the same POS provisions as TRICARE Prime beneficiaries. They must coordinate care with their PCM, or they will be required to pay the higher 50 percent cost-share and a deductible.
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