Do you see TRICARE patients? Check out CMA's new toolkit to assist physicians with the transition On January 1, 2018, Health Net Federal Services (HNFS) will begin providing managed care services to 2.9 million TRICARE beneficiaries in the 21 western states, including California. HNFS took over the contract previously held by UnitedHealthcare Military and Veterans’ Services. In preparation for the transition, the California Medical Association (CMA) has prepared a TRICARE Transition Guide to help physicians understand the impact the transition will have on their practices. The guide is available free to members in the CMA resource library. December 28, 2017 Managed Care Health Net, TRICARE 0 0 Comment Read More »
Health Net Federal Services begins TRICARE contracting initiative As previously reported, the Department of Defense awarded the $17.7 billion TRICARE West Region contract to Health Net Federal Services (HNFS). As the recipient of the contract, HNFS will provide managed care services to 2.9 million TRICARE beneficiaries in 19 western states, including California, beginning October 1, 2017. In preparation for the transition, Health Net has sent recruitment notices to physicians soliciting interest in participation in the new Health Net Federal Services (HNFS) West Region network. Included in the recruitment packet is a “Join our Network” form. Physicians interested in joining the HNFS network should return the completed form to HNFS via email, fax or mail. According to Health Net, submission of the “Join our Network” form is only an expression of interest and does not obligate the physician to participate. HNFS will then mail the physician a contract offer approximately 72 hours after receipt of the completed form. Physicians will have the opportunity to review the contract terms before making a final decision. Physicians should be aware that terms of the HNFS contract may vary from the prior United Healthcare Military and Veterans (UMVS) TRICARE contract. Providers are encouraged to closely review the proposed contract terms. The California Medical Association (CMA) is in the process of reviewing the HNFS contract and will publish an update as soon as more information is available. During the 2013 transition of TRICARE managed care services from TriWest to UMVS, a CMA survey found widespread reports of problems, including contracting issues and significant delays in processing of authorizations and referral requests, which delayed timely access to medical care. CMA has shared feedback with HNFS on the flawed transition to UMVS. HNFS advised that it has been a continuous TRICARE administrative contractor for 28 years, has an existing medical management system in place in the North Region that it will be utilizing and that it, along with the Department of Defense, is taking proactive steps to ensure the transition goes smoothly. CMA will work closely with HNFS on the transition and will be publishing a TRICARE transition guide to provide assistance to physician practices. Physicians with questions regarding the TRICARE amendment may contact HNFS at HNFSProvRel@healthnet.com. April 18, 2017 Managed Care Health Net Federal Services, HNFS, Managed Care, TRICARE 0 0 Comment Read More »
Health Net Federal Services awarded Tricare contract beginning late 2017 Health Net Federal Services (HNFS) has been awarded the contract for managed care support (MCS) for the Tricare West Region, replacing the current MCS contractor, United Military and Veteran Services. Under the $17.7 billion contract, HNFS will provide direct medical care and administrative support services to Tricare beneficiaries throughout the 19 state western region, which includes California. According to HNFS, a nine-month transition period is expected, with an anticipated start of health care delivery sometime in mid-2017. HNFS has been the managed care contractor for the Tricare North Region since 2004, servicing approximately 2.8 million beneficiaries in 22 states and the District of Columbia. August 9, 2016 Managed Care Tricare, Health Net 0 0 Comment Read More »
Ask the expert: How long does TRICARE have to request a refund? Recently, physicians may have started to receive TRICARE requests for refunds related to overpayment from the governmental health carrier. As a result, the California Medical Association’s Center for Economic Services has compiled a list of the most frequently asked questions and answers related to these TRICARE refund requests. How long does TRICARE have to request a refund? Pursuant to federal law, TRICARE is authorized to seek refunds of overpayment for dates of service as far back as 10 years, per Title 32: Subtitle A, Chapter: 1, Subchapter M, Part 199.11 - Overpayments recovery. (f) (6) (E) (v)). How long does a physician practice have to respond to the overpayment request? Physicians have 30 days to respond to the refund request. Failure to respond will result in the offset of monies against future payments until the full overpayment amount is received. Can I bill the member for the balance? Physicians should review the overpayment notice very carefully. In some instances, patients may be held financially responsible for the amounts owed. September 4, 2014 General Refund Requests, Tricare, Practice Resources 0 0 Comment Read More »
Government shutdown to have minimal impact on Medicare and TRICARE programs With the October 1 shutdown of the federal government, the California Medical Association (CMA) has received calls from physicians with questions about how federally funded programs like Medicare and TRICARE will be affected. TRICARE On October 1, 2013, the Defense Health Agency issued a statement regarding TRICARE programs, indicating that there will be minimal impact to TRICARE beneficiaries utilizing private sector physicians. CMA has also confirmed with United Healthcare Military & Veterans Services, the managed care support contractor for the TRICARE West Region, that there should be no interruption in operations including utilization management and physician reimbursements. Medicare On October 1, the Centers for Medicare and Medicaid Services (CMS) announced in its MLN Connects Provider eNews that while the government shutdown is in effect, Medicare Administrative Contractors will continue to perform all functions related to Medicare fee-for-service claims processing and payment. There should be no effect on payments to physicians. CMA has also received questions about whether the PQRS payment adjustment exemption deadline of October 15 will be extended. CMS reports that neither the portal nor the help desk have been affected by the government shutdown. While CMS reports the portal was down briefly on October 3, the issue was resolved quickly. Slower response times are likely due to the increased volume of providers trying to access the system as the deadline approaches. Contact: Michele Kelly, (213) 226-0338 or mkelly@cmanet.org. October 4, 2013 General Medicare, TRICARE, Insurance/Reimbursement 0 0 Comment Read More »
TRICARE Transition Guide On April 1, 2013, United Health Military & Veterans Services (UMVS) began providing managed care services to 2.9 million TRICARE beneficiaries in the 21 western states, including California. On that date, UMVS took over the contract previously held by TriWest. To help physicians understand the impact the transition will have on their practices, CMA has prepared a TRICARE Transition Guide. (members only; login required) April 2, 2013 General, Managed Care Managed Care Services, UMVS, TRICARE, United Health Military and Veterans Services 0 0 Comment Read More »
