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Effective mid-2017, the Department of Defense will re-structure TRICARE—the health program for active duty and retired military service members and their families—into two administrative regions. Historically, there have been three TRICARE regions. Under this new structure, TRICARE East will be managed by Humana Military and TRICARE West will be managed by HealthNet Federal Services. Benefits received by TRICARE participants will not change, but urgent care providers do need to be aware of changes to billing and reimbursement under the new administrative structure.
In order to continue to see TRICARE members, urgent care centers need to apply to join the networks administered by Humana and HealthNet. Existing contracts with UnitedHealthcare, the current TRICARE West administrator, will be in effect until mid-2017 when the current TRICARE contract terminates.
Participating providers in TRICARE agree to use the administrator’s web-based tools to check beneficiary eligibility, validate whether services require pre-authorization, submit authorization and referral requests, and submit claims electronically. This is in addition to accepting a reimbursement discount on TRICARE’s maximum allowable charge. Failure to become contracted/credentialed with the new TRICARE administrators as soon as possible may result in termination from the program.
PV Billing provides comprehensive contracting and credentialing services to assure optimal reimbursement rates for its clients. PV Billing, part of Practice Velocity, offers full-service revenue cycle management services that include fast accurate claim review and submission, electronic data interface and remittance, accounts receivable and denial management, payment posting, and refund processing. PV Billing also monitors reimbursement to ensure payment at contracted rates and assists clients in maximizing revenue with collection rates above national standards.