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TRICARE West Region Medical/Surgical
Basics for the Provider
TRICARE West Region Customer Service: 877-988-9378(WEST) - UHCMilitaryWest.com. “TRICARE,” “TRICARE Prime,” “TRICARE Reserve Select,” and “TRICARE Retired Reserve” are registered trademarks
of the Defense Health Agency. All Rights Reserved. This presentation reflects the program as of the date delivered and is subject to change. Administrative guides and the Provider Handbook should be consulted
regarding policies and procedures.
2 Doc#: PCA12480_20140428
Presentation Outline
• Introduction to TRICARE
• Eligibility
• Referral and Authorizations
• Programs and Benefits
• Clinical Programs
• Provider Types and Access Standards
• Claims and Reimbursement
• Provider Resources
• Behavioral Health
• Updates and Highlights
• DME Updates and Prescription
• Premium Designation
Introduction to TRICARE
TRICARE West Region Customer Service: 877-988-9378(WEST) - UHCMilitaryWest.com. “TRICARE,” “TRICARE Prime,” “TRICARE Reserve Select,” and “TRICARE Retired Reserve” are registered trademarks
of the Defense Health Agency. All Rights Reserved. This presentation reflects the program as of the date delivered and is subject to change. Administrative guides and the Provider Handbook should be consulted
regarding policies and procedures.
4 Doc#: PCA12480_20140428
What is TRICARE?
TRICARE is …
the health care program for active duty service members, National Guard and
Reserve members, retirees, family members, young adults, survivors and certain
former spouses worldwide.
a network of Military Health System resources and civilian health care
professionals working together to foster, protect, sustain, and restore health for
those entrusted to their care.
TRICARE West Region Customer Service: 877-988-9378(WEST) - UHCMilitaryWest.com. “TRICARE,” “TRICARE Prime,” “TRICARE Reserve Select,” and “TRICARE Retired Reserve” are registered trademarks
of the Defense Health Agency. All Rights Reserved. This presentation reflects the program as of the date delivered and is subject to change. Administrative guides and the Provider Handbook should be consulted
regarding policies and procedures.
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TRICARE is available worldwide and managed regionally.
Humana Military
Healthcare Services
South Region
TRICARE West Region
UnitedHealthcare
Military & Veterans
West Region
HealthNet Federal Services
North Region
TRICARE West Region Customer Service: 877-988-9378(WEST) - UHCMilitaryWest.com. “TRICARE,” “TRICARE Prime,” “TRICARE Reserve Select,” and “TRICARE Retired Reserve” are registered trademarks
of the Defense Health Agency. All Rights Reserved. This presentation reflects the program as of the date delivered and is subject to change. Administrative guides and the Provider Handbook should be consulted
regarding policies and procedures.
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TRICARE West Region Contractor
UnitedHealth Group
• National, diversified health and well-being company dedicated to making the health
care system work better
UnitedHealthcare Military & Veterans
• A division of UnitedHealth Group
• An administrator/managed care support contractor for the Department of Defense
(DOD)
• Behavioral health and specialty networks provided through our vendor OptumHealth
TRICARE West Region Customer Service: 877-988-9378(WEST) - UHCMilitaryWest.com. “TRICARE,” “TRICARE Prime,” “TRICARE Reserve Select,” and “TRICARE Retired Reserve” are registered trademarks
of the Defense Health Agency. All Rights Reserved. This presentation reflects the program as of the date delivered and is subject to change. Administrative guides and the Provider Handbook should be consulted
regarding policies and procedures.
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Military Treatment Facilities
• Military Treatment Facilities (MTFs) provide care for Active Duty Service
Members and other beneficiaries depending on available space.
• MTFs vary from large teaching facilities, such as Naval Medical Center San
Diego, to smaller primary care clinics with no specialty care.
• TRICARE network providers augment the care available at the MTFs.
TRICARE West Region Customer Service: 877-988-9378(WEST) - UHCMilitaryWest.com. “TRICARE,” “TRICARE Prime,” “TRICARE Reserve Select,” and “TRICARE Retired Reserve” are registered trademarks
of the Defense Health Agency. All Rights Reserved. This presentation reflects the program as of the date delivered and is subject to change. Administrative guides and the Provider Handbook should be consulted
regarding policies and procedures.
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Behavioral Health and PT/OT/ST
Strong, specialized network in the 21 West Region states
• Behavioral health clinicians and facilities contracted through Optum/UnitedHealthcare
• Physical therapy, occupational therapy and speech therapy free-standing clinics
• Serves beneficiary and provider needs
TRICARE Eligibility
TRICARE West Region Customer Service: 877-988-9378(WEST) - UHCMilitaryWest.com. “TRICARE,” “TRICARE Prime,” “TRICARE Reserve Select,” and “TRICARE Retired Reserve” are registered trademarks
of the Defense Health Agency. All Rights Reserved. This presentation reflects the program as of the date delivered and is subject to change. Administrative guides and the Provider Handbook should be consulted
regarding policies and procedures.
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10 Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Eligible TRICARE Populations
Active Duty Service Member (ADSM) & family (ADFM)
Retired Service Member and dependents
Young adult up to age 26
Activated National Guard/Reserve and family
Retired National Guard/Reserve (age 60+) and family
Medal of Honor recipient and family
Other eligible beneficiaries
• survivors
• eligible former spouses
• eligible National Oceanic and Atmospheric Administration (NOAA)
TRICARE West Region Customer Service: 877-988-9378(WEST) - UHCMilitaryWest.com. “TRICARE,” “TRICARE Prime,” “TRICARE Reserve Select,” and “TRICARE Retired Reserve” are registered trademarks
of the Defense Health Agency. All Rights Reserved. This presentation reflects the program as of the date delivered and is subject to change. Administrative guides and the Provider Handbook should be consulted
regarding policies and procedures.
11 Doc#: PCA12480_20140428
This presentation reflects the program as of the date delivered and is subject to change. Administrative guides and the Provider Handbook should be consulted regarding policies and procedures.
TRICARE Eligibility
Verify Patient Status
• Check Military ID or Common Access Card (CAC) on Date of Service
• Use sponsor’s social security number (SSN) or unique Defense benefit number
(DBN) located on back of the ID card
• Validate benefits and eligibility
• Check expiration date
Resources • UnitedHealthcare Military & Veterans
• Provider service: 877-988-9378
• Secure website* UHCMilitaryWest.com
• PGBA Claims Administrator
• Secure website* www.mytricare.com
*Secure portion requires registration
TRICARE West Region Customer Service: 877-988-9378(WEST) - UHCMilitaryWest.com. “TRICARE,” “TRICARE Prime,” “TRICARE Reserve Select,” and “TRICARE Retired Reserve” are registered trademarks
of the Defense Health Agency. All Rights Reserved. This presentation reflects the program as of the date delivered and is subject to change. Administrative guides and the Provider Handbook should be consulted
regarding policies and procedures.
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Transition from SSN to DBN Newly formatted military and family member ID cards
• 11-digit DoD Benefits Number (DBN) replaces 9-digit Social Security Number (SSN)
• 10-digit DOD ID Number is not used for claims billing
H65 edit alert (invalid Member ID)
• numbers with 10 digits or dashes
12
Doc#: UHC2146v.2_20130725
TRICARE Referrals and Authorizations
TRICARE West Region Customer Service: 877-988-9378(WEST) - UHCMilitaryWest.com. “TRICARE,” “TRICARE Prime,” “TRICARE Reserve Select,” and “TRICARE Retired Reserve” are registered trademarks
of the Defense Health Agency. All Rights Reserved. This presentation reflects the program as of the date delivered and is subject to change. Administrative guides and the Provider Handbook should be consulted
regarding policies and procedures.
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Referrals and Authorizations - defined
Referral: The process of sending a patient to another professional provider for a
consultation or health care service.
Prior Authorization: A request for services, procedures or admission to a hospital or facility that is
obtained before a service is provided. Prior authorization is not required for
emergencies.
Resources
• Prior Authorization List UHCMilitaryWest.com
• No Government Pay Procedure Code List www.tricare.mil/nogovernmentpay/
14 Doc#: UHC2146v.2_20130725
TRICARE West Region Customer Service: 877-988-9378(WEST) - UHCMilitaryWest.com. “TRICARE,” “TRICARE Prime,” “TRICARE Reserve Select,” and “TRICARE Retired Reserve” are registered trademarks
of the Defense Health Agency. All Rights Reserved. This presentation reflects the program as of the date delivered and is subject to change. Administrative guides and the Provider Handbook should be consulted
regarding policies and procedures.
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Referrals and Authorizations (non-behavioral)
Active Duty Service Member (ADSM):
Referrals and authorizations are required for all inpatient and outpatient services
Referrals are necessary for:
TRICARE Prime (Active Duty or Retired)
TRICARE Prime Remote (Active Duty and Family)
TRICARE Young Adult (TYA) Prime (AD/Retired)
Authorizations are needed for:
• Any procedure on the Prior Authorization List (all program options)
• All care provided under the Extended Care Health Option (ECHO)
Authorization requests must include supporting clinical information
15 Doc#: UHC2146v.2_20130725
TRICARE West Region Customer Service: 877-988-9378(WEST) - UHCMilitaryWest.com. “TRICARE,” “TRICARE Prime,” “TRICARE Reserve Select,” and “TRICARE Retired Reserve” are registered trademarks
of the Defense Health Agency. All Rights Reserved. This presentation reflects the program as of the date delivered and is subject to change. Administrative guides and the Provider Handbook should be consulted
regarding policies and procedures.
16 Doc#: PCA12480_20140428
Prior Authorization List
Important references to determine if authorization is required:
Narrative Prior Authorization List
Questionable Services List
UHCMilitaryWest.com > Providers > Referrals and Prior Authorizations
• Scroll to end of page for Information links
No Government Pay List - codes excluded from TRICARE coverage and
not payable
• http://tricare.mil/nogovernmentpay/
Referral/Authorization approval is required before providing services.
TRICARE West Region Customer Service: 877-988-9378(WEST) - UHCMilitaryWest.com. “TRICARE,” “TRICARE Prime,” “TRICARE Reserve Select,” and “TRICARE Retired Reserve” are registered trademarks
of the Defense Health Agency. All Rights Reserved. This presentation reflects the program as of the date delivered and is subject to change. Administrative guides and the Provider Handbook should be consulted
regarding policies and procedures.
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Referrals and Authorizations (non-behavioral)
Primary Care Managers and Specialists can submit referral and
authorization requests.
• Select a network/contracted provider from the provider directory at
UHCMilitaryWest.com or leave the field blank (TRICARE will select a
network provider)
• Network provider selection benefits the beneficiary by:
• Avoiding Prime and Prime Remote Point of Service (POS) billing
issues
• Reduces standard out-of-pocket expenses
TRICARE West Region Customer Service: 877-988-9378(WEST) - UHCMilitaryWest.com. “TRICARE,” “TRICARE Prime,” “TRICARE Reserve Select,” and “TRICARE Retired Reserve” are registered trademarks
of the Defense Health Agency. All Rights Reserved. This presentation reflects the program as of the date delivered and is subject to change. Administrative guides and the Provider Handbook should be consulted
regarding policies and procedures.
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Referrals and Authorizations (non-behavioral)
What is Urgent Care? Medically necessary services (i.e. a sprain, sore throat, or rising temperature) that are required for illness or injury that would not result in further disability or death if not treated immediately.
Requires professional attention, and has the potential to develop into such a threat if treatment is delayed longer than 24 hours
Referral needed for the Prime beneficiary
• TRICARE Prime beneficiaries must receive referrals from their PCMs or UnitedHealthcare Military & Veterans before receiving urgent care
• A claim without a referral could be paid under Point Of Service (POS).
TRICARE West Region Customer Service: 877-988-9378(WEST) - UHCMilitaryWest.com. “TRICARE,” “TRICARE Prime,” “TRICARE Reserve Select,” and “TRICARE Retired Reserve” are registered trademarks
of the Defense Health Agency. All Rights Reserved. This presentation reflects the program as of the date delivered and is subject to change. Administrative guides and the Provider Handbook should be consulted
regarding policies and procedures.
19 Doc#: PCA12480_20140428 Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Referrals and Authorizations (non-behavioral)
Inpatient Notification
• fax 877-578-2738
• needs cover sheet with medical, surgical, and maternity notification
(OB requires authorizations for both global physician care and the hospital stay)
• is required for any scheduled non-emergent admission
• is not required for outpatient observation
Emergency care “In the event of a medical, maternity or psychiatric condition leading to life, limb, or eyesight threatening emergency, the beneficiary should go, or be taken, to the nearest emergency room or appropriate medical facility”
• Notify within 24 hours of an emergency admission (including weekend notifications)
• Certain medical/surgical/behavioral health care services are reviewed for medical necessity and appropriateness of care prior to services being rendered or within 24 hours of an emergency admission
TRICARE West Region Customer Service: 877-988-9378(WEST) - UHCMilitaryWest.com. “TRICARE,” “TRICARE Prime,” “TRICARE Reserve Select,” and “TRICARE Retired Reserve” are registered trademarks
of the Defense Health Agency. All Rights Reserved. This presentation reflects the program as of the date delivered and is subject to change. Administrative guides and the Provider Handbook should be consulted
regarding policies and procedures.
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Submit Referral and Authorization - Fax
Fax Referral and Authorization requests
877-578-2738 Inpatient admission face sheets
877-890-8203 Urgent requests (care required within 24-72 hours)
Response within 24 hours
877-890-9309 Routine requests
Response within 3-5 business days
877-581-1590 Behavioral Health urgent and routine requests
TRICARE Patient Referral/Authorization Form (Blank and “Type & Print”)
• UHCMilitaryWest.com > Medical/Surgical Referral/Authorization > Find a Form
TRICARE West Region Customer Service: 877-988-9378(WEST) - UHCMilitaryWest.com. “TRICARE,” “TRICARE Prime,” “TRICARE Reserve Select,” and “TRICARE Retired Reserve” are registered trademarks
of the Defense Health Agency. All Rights Reserved. This presentation reflects the program as of the date delivered and is subject to change. Administrative guides and the Provider Handbook should be consulted
regarding policies and procedures.
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Submit Referral and Authorization- Online
Register for the website and then submit requests online
• Available to UnitedHealthcare Military & Veterans network providers
• Log in to your account at UHCMilitaryWest.com
• Use the Submit Referral or Authorization Request link
Recently added features:
• Send attachments
• Select an Episode of Care (EOC)
TRICARE West Region Customer Service: 877-988-9378(WEST) - UHCMilitaryWest.com. “TRICARE,” “TRICARE Prime,” “TRICARE Reserve Select,” and “TRICARE Retired Reserve” are registered trademarks
of the Defense Health Agency. All Rights Reserved. This presentation reflects the program as of the date delivered and is subject to change. Administrative guides and the Provider Handbook should be consulted
regarding policies and procedures.
22 Doc#: PCA12480_20140428
Supporting Documents
Supporting documentation, such as clinical notes, can be added to the request.
Here are some simple rules:
• You may attach up to 10 documents.
• Each document can be no larger than 25 MB.
Several file formats are supported, including: .txt, .pdf, .doc, .docx, .xls, and .xlsx.
Picture formats are also supported and include: .gif, .jpeg, and .tif.
TRICARE West Region Customer Service: 877-988-9378(WEST) - UHCMilitaryWest.com. “TRICARE,” “TRICARE Prime,” “TRICARE Reserve Select,” and “TRICARE Retired Reserve” are registered trademarks
of the Defense Health Agency. All Rights Reserved. This presentation reflects the program as of the date delivered and is subject to change. Administrative guides and the Provider Handbook should be consulted
regarding policies and procedures.
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Episode of Care (EOC)
• Select an EOC from the drop down menu.
• Click on View CPT Code Description to see the CPT codes associated with the selected EOC.
• Additional CPT Codes may be added in the box for CPT Code/HCPCS Code.
TRICARE West Region Customer Service: 877-988-9378(WEST) - UHCMilitaryWest.com. “TRICARE,” “TRICARE Prime,” “TRICARE Reserve Select,” and “TRICARE Retired Reserve” are registered trademarks
of the Defense Health Agency. All Rights Reserved. This presentation reflects the program as of the date delivered and is subject to change. Administrative guides and the Provider Handbook should be consulted
regarding policies and procedures.
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Procedure(s)/Service(s)
Click the Add Additional
Procedure/Service link if you
have more CPT/HCPCS Codes to
enter.
TRICARE West Region Customer Service: 877-988-9378(WEST) - UHCMilitaryWest.com. “TRICARE,” “TRICARE Prime,” “TRICARE Reserve Select,” and “TRICARE Retired Reserve” are registered trademarks
of the Defense Health Agency. All Rights Reserved. This presentation reflects the program as of the date delivered and is subject to change. Administrative guides and the Provider Handbook should be consulted
regarding policies and procedures.
25 Doc#: PCA12480_20140428
Referrals and Authorizations (non-behavioral)
Right of First Refusal (ROFR)
ROFR is given when a MTF has the specialty capability and available appointment
times to care for the Prime beneficiary.
• MTF directs ALL care for ADSMs
• MTF is always the primary source of care for Prime beneficiaries living within the
Prime Service Area (PSA)
• ROFR does not apply to seeking care at MTFs for TRICARE Prime Remote,
TRICARE Prime Remote Active Duty Family Member and TRICARE Standard
• Additional referrals/authorizations may be denied if the MTF has capacity for
specialty services
TRICARE West Region Customer Service: 877-988-9378(WEST) - UHCMilitaryWest.com. “TRICARE,” “TRICARE Prime,” “TRICARE Reserve Select,” and “TRICARE Retired Reserve” are registered trademarks
of the Defense Health Agency. All Rights Reserved. This presentation reflects the program as of the date delivered and is subject to change. Administrative guides and the Provider Handbook should be consulted
regarding policies and procedures.
26 Doc#: PCA12480_20140428
Referrals and Authorizations (non-behavioral)
Referral/Authorization Appointment Process
Beneficiary is notified via letter, email, or text message to schedule an appointment and notify UnitedHealthcare Military & Veterans of the appointment date by calling 877-988-9378 (WEST)
Requesting specialist and facility receive a copy of the beneficiary letter and approved referral/authorization. Approvals are sent by mail, however, the rendering providers who are enrolled in the fax notification program will receive a faxed approval.
• Call 877-644-4315 if a rendering provider is interested in the fax notification program
Providers may check status at UHCMilitaryWest.com after registration
Providers may request additional services by submitting Referral/Authorization form online or by fax
Specialty referrals valid up to a 180 day max
• exception: obstetrician (OB) is covered for 312 days
TRICARE West Region Customer Service: 877-988-9378(WEST) - UHCMilitaryWest.com. “TRICARE,” “TRICARE Prime,” “TRICARE Reserve Select,” and “TRICARE Retired Reserve” are registered trademarks
of the Defense Health Agency. All Rights Reserved. This presentation reflects the program as of the date delivered and is subject to change. Administrative guides and the Provider Handbook should be consulted
regarding policies and procedures.
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Search Referrals and Prior Authorizations
After submitting a Referral or Authorization Request, you can then search for
the request to view its status.
• If you are not already logged-in, log in to your UHCMilitaryWest.com
account.
• From the left navigation, click on the Search Referral and Prior
Authorizations link.
TRICARE West Region Customer Service: 877-988-9378(WEST) - UHCMilitaryWest.com. “TRICARE,” “TRICARE Prime,” “TRICARE Reserve Select,” and “TRICARE Retired Reserve” are registered trademarks
of the Defense Health Agency. All Rights Reserved. This presentation reflects the program as of the date delivered and is subject to change. Administrative guides and the Provider Handbook should be consulted
regarding policies and procedures.
28 Doc#: PCA12480_20140428
Search Results
Referral or Authorization Requests submitted online will appear in “Pending” status until they
are processed.
To view the details of the Referral or Authorization,
click on the Reference Number Link.
Office Managers will only be able to view referrals and authorizations
of patients for the specific provider they are logged-in as on the portal.
To view referrals and authorizations for all providers on the account, click
the Switch Provider link in the header to view each Provider individually.
TRICARE Programs
TRICARE West Region Customer Service: 877-988-9378(WEST) - UHCMilitaryWest.com. “TRICARE,” “TRICARE Prime,” “TRICARE Reserve Select,” and “TRICARE Retired Reserve” are registered trademarks
of the Defense Health Agency. All Rights Reserved. This presentation reflects the program as of the date delivered and is subject to change. Administrative guides and the Provider Handbook should be consulted
regarding policies and procedures.
30 Doc#: PCA12480_20140428
TRICARE Programs (product types)
TRICARE Prime
Managed care option
Offered in Prime Service Areas (PSAs) within a 40 mile radius of a MTF
Beneficiary enrolled to Primary Care Manager (PCM) at the MTF or network provider
Referrals made to network specialty providers
Authorizations required if on the Prior Authorization List
Lowest out-of-pocket costs
Point of Service (POS) option
• Deductible: $300 individual, $600 family
• 50 percent cost share
TRICARE West Region Customer Service: 877-988-9378(WEST) - UHCMilitaryWest.com. “TRICARE,” “TRICARE Prime,” “TRICARE Reserve Select,” and “TRICARE Retired Reserve” are registered trademarks
of the Defense Health Agency. All Rights Reserved. This presentation reflects the program as of the date delivered and is subject to change. Administrative guides and the Provider Handbook should be consulted
regarding policies and procedures.
31 Doc#: PCA12480_20140428
TRICARE Programs (product types)
TRICARE Prime Remote (TPR) Managed care option
Similar to Prime, TRICARE Prime Remote (TPR) is for the ADSM and the Active Duty Family Member (TPRADFM)
Prime Remote is for ADSMs:
• While assigned to remote US duty stations
• Who live and work more than 50 miles or one hour drive from an MTF
• National Guard/Reserve called to Active Duty Status and their families may be eligible
TRICARE West Region Customer Service: 877-988-9378(WEST) - UHCMilitaryWest.com. “TRICARE,” “TRICARE Prime,” “TRICARE Reserve Select,” and “TRICARE Retired Reserve” are registered trademarks
of the Defense Health Agency. All Rights Reserved. This presentation reflects the program as of the date delivered and is subject to change. Administrative guides and the Provider Handbook should be consulted
regarding policies and procedures.
32 Doc#: PCA12480_20140428
TRICARE Programs (product types)
TRICARE Standard and TRICARE Extra
TRICARE Standard (like a traditional fee-for-service option)
• Care from a TRICARE-authorized non-network provider
• Most expensive out-of-pocket fiscal year (FY) deductible and cost-shares
TRICARE Extra (like a preferred provider option)
• Care from a network provider
• Reduced five percent FY deductibles and cost shares
No PCM enrollment required
No referrals required
Prior authorization required before performing services on the Prior Authorization List
TRICARE West Region Customer Service: 877-988-9378(WEST) - UHCMilitaryWest.com. “TRICARE,” “TRICARE Prime,” “TRICARE Reserve Select,” and “TRICARE Retired Reserve” are registered trademarks
of the Defense Health Agency. All Rights Reserved. This presentation reflects the program as of the date delivered and is subject to change. Administrative guides and the Provider Handbook should be consulted
regarding policies and procedures.
33 Doc#: PCA12480_20140428
TRICARE Programs (product types)
TRICARE Young Adult (TYA)
Similar to TRICARE Standard/Extra/Prime
Eligible dependent age 21 (or 23 if full time student), up to age 26
Need to meet specific criteria to be eligible
Premium-based health plan
TRICARE West Region Customer Service: 877-988-9378(WEST) - UHCMilitaryWest.com. “TRICARE,” “TRICARE Prime,” “TRICARE Reserve Select,” and “TRICARE Retired Reserve” are registered trademarks
of the Defense Health Agency. All Rights Reserved. This presentation reflects the program as of the date delivered and is subject to change. Administrative guides and the Provider Handbook should be consulted
regarding policies and procedures.
34 Doc#: PCA12480_20140428
TRICARE Programs (product types)
TRICARE Reserve Select (TRS)
Similar to TRICARE Standard/Extra (deductible and cost share)
TRS coverage for National Guard/Reserve eligible members
Premium-based health plan
Authorizations required for services listed on the Prior Authorization List
Prior authorizations required before performing
services on the Prior Authorization List
TRICARE West Region Customer Service: 877-988-9378(WEST) - UHCMilitaryWest.com. “TRICARE,” “TRICARE Prime,” “TRICARE Reserve Select,” and “TRICARE Retired Reserve” are registered trademarks
of the Defense Health Agency. All Rights Reserved. This presentation reflects the program as of the date delivered and is subject to change. Administrative guides and the Provider Handbook should be consulted
regarding policies and procedures.
35 Doc#: PCA12480_20140428
TRICARE Programs (product types)
TRICARE Retired Reserve (TRR)
Similar to TRICARE Reserve Select (deductible and cost share)
Premium-base health plan
Specific criteria for eligible Retired Reservist
Prior authorization required for services on the Prior Authorization list
TRICARE West Region Customer Service: 877-988-9378(WEST) - UHCMilitaryWest.com. “TRICARE,” “TRICARE Prime,” “TRICARE Reserve Select,” and “TRICARE Retired Reserve” are registered trademarks
of the Defense Health Agency. All Rights Reserved. This presentation reflects the program as of the date delivered and is subject to change. Administrative guides and the Provider Handbook should be consulted
regarding policies and procedures.
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TRICARE Programs (product types)
TRICARE for Life (TFL) NOT Administered by UnitedHealthcare
TRICARE’s Medicare-wraparound coverage
Available to all TRICARE and Medicare (Part A & B) dual-eligible beneficiaries
Contact Wisconsin Physicians Service (WPS)
866-773-0404 or www.tricare4u.com for
• Benefits
• Claims
• Requirements
Claims filed with Medicare are electronically forwarded to WPS/TFL
TRICARE West Region Customer Service: 877-988-9378(WEST) - UHCMilitaryWest.com. “TRICARE,” “TRICARE Prime,” “TRICARE Reserve Select,” and “TRICARE Retired Reserve” are registered trademarks
of the Defense Health Agency. All Rights Reserved. This presentation reflects the program as of the date delivered and is subject to change. Administrative guides and the Provider Handbook should be consulted
regarding policies and procedures.
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Extended Care Health Option (ECHO)
Provides additional healthcare coverage benefits to ADFMs with special needs
Beneficiaries must qualify based on specific mental or physical disabilities and
register with their military branch Exceptional Family Member Plan (EFMP)
Offers integrated set of services and supplies beyond basic TRICARE benefits
Requires prior authorizations for all services
TRICARE Programs (product types)
TRICARE West Region Customer Service: 877-988-9378(WEST) - UHCMilitaryWest.com. “TRICARE,” “TRICARE Prime,” “TRICARE Reserve Select,” and “TRICARE Retired Reserve” are registered trademarks
of the Defense Health Agency. All Rights Reserved. This presentation reflects the program as of the date delivered and is subject to change. Administrative guides and the Provider Handbook should be consulted
regarding policies and procedures.
38 Doc#: PCA12480_20140428
Other DOD Health Care Programs
Supplemental Health Care Program (SHCP):
• ADSM and Guard/Reserve with valid Line of Duty injuries may be referred to the network
Transitional Health Care Benefits (TAMP and TCSRC):
• TAMP is transitional coverage for ADSM and family upon separation from Active Duty
• TCSRC is Transitional coverage for the ADSM only
Continued Health Care Benefit Program (CHCBP):
• Transitional coverage (possibly 18–36 months) to former service members and their families, eligible non-remarried former spouses and emancipated children living on their own. Enrollment required with quarterly premiums.
• DoD contracted Humana Military Healthcare Services, Inc. to administer program
US Family Health Plan: (Active Duty Service Members are ineligible)
• A TRICARE Prime Option available in six service areas across the country
TRICARE Dental Programs:
• NOT administered by UnitedHealthcare Military & Veterans
TRICARE West Region Customer Service: 877-988-9378(WEST) - UHCMilitaryWest.com. “TRICARE,” “TRICARE Prime,” “TRICARE Reserve Select,” and “TRICARE Retired Reserve” are registered trademarks
of the Defense Health Agency. All Rights Reserved. This presentation reflects the program as of the date delivered and is subject to change. Administrative guides and the Provider Handbook should be consulted
regarding policies and procedures.
39 Doc#: PCA12480_20140428
TRICARE Programs
TRICARE Pharmacy Benefits
MTF pharmacies are the least expensive option
• Availability may vary by MTF pharmacy location
TRICARE Pharmacy Home Delivery (formerly TRICARE Mail Order Pharmacy)
• Preferred method when not using an MTF pharmacy
• Contractor is Express Scripts: www.express-scripts.com/TRICARE
TRICARE retail network pharmacies
• Network of approximately 60,000 retail pharmacies
Non-network retail pharmacies (most expensive option)
TRICARE
Clinical Programs
TRICARE West Region Customer Service: 877-988-9378(WEST) - UHCMilitaryWest.com. “TRICARE,” “TRICARE Prime,” “TRICARE Reserve Select,” and “TRICARE Retired Reserve” are registered trademarks
of the Defense Health Agency. All Rights Reserved. This presentation reflects the program as of the date delivered and is subject to change. Administrative guides and the Provider Handbook should be consulted
regarding policies and procedures.
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TRICARE Clinical Programs
Condition (Disease) Management
UnitedHealthcare Military & Veterans covers medical, surgical and behavioral health
management for the following conditions:
• Asthma (adult and children)
• Chronic Heart Failure
• Chronic Obstructive Pulmonary Disease (COPD)
• Cancer Screening
• Diabetes
• Depression
• Anxiety Disorder
TRICARE West Region Customer Service: 877-988-9378(WEST) - UHCMilitaryWest.com. “TRICARE,” “TRICARE Prime,” “TRICARE Reserve Select,” and “TRICARE Retired Reserve” are registered trademarks
of the Defense Health Agency. All Rights Reserved. This presentation reflects the program as of the date delivered and is subject to change. Administrative guides and the Provider Handbook should be consulted
regarding policies and procedures.
42 Doc#: PCA12480_20140428
TRICARE Clinical Programs
Case Management
Programs include:
• Medical, surgical and behavior health case management
Specialty programs
• Extended Care Health Option (ECHO/Autism Demonstration)
• Extended Home Health Care (EHHC)
• Custodial Care Transition Policy (CCTP)
• Transplants, cancer clinical trials, etc.
• Warrior Advocate Program (high risk/cost, seriously ill ADSMs)
Referring a TRICARE beneficiary to Case Management
• Download Case Management Patient Referral Form UHCMilitaryWest.com > Provider > Find a Form > Med-Surg. Referrals & Auths
• Call UnitedHealthcare Military & Veterans: 877-988-9378 (WEST)
TRICARE Provider Types
TRICARE West Region Customer Service: 877-988-9378(WEST) - UHCMilitaryWest.com. “TRICARE,” “TRICARE Prime,” “TRICARE Reserve Select,” and “TRICARE Retired Reserve” are registered trademarks
of the Defense Health Agency. All Rights Reserved. This presentation reflects the program as of the date delivered and is subject to change. Administrative guides and the Provider Handbook should be consulted
regarding policies and procedures.
44 Doc#: PCA12480_20140428
TRICARE Provider Types
All authorized providers meet state licensing and TRICARE certification requirements
e.g., physicians, hospitals, ancillary providers, pharmacies, et al.
Network Providers have signed a TRICARE agreement to accept assignment, file claims and other paperwork for TRICARE beneficiaries
• Participating Non-Network Providers
• participate on claim-by-claim basis
• accept allowable charge and direct payment from TRICARE
Non-Network Providers (out of network) have not signed a TRICARE agreement
• Non-participating Non-Network Providers
• do not accept TRICARE allowable charge or file claims for beneficiaries
• can legally charge up to 15 percent above TRICARE allowable charges
TRICARE West Region Customer Service: 877-988-9378(WEST) - UHCMilitaryWest.com. “TRICARE,” “TRICARE Prime,” “TRICARE Reserve Select,” and “TRICARE Retired Reserve” are registered trademarks
of the Defense Health Agency. All Rights Reserved. This presentation reflects the program as of the date delivered and is subject to change. Administrative guides and the Provider Handbook should be consulted
regarding policies and procedures.
45 Doc#: PCA12480_20140428
TRICARE Network Providers
Network providers may only bill a beneficiary for:
• deductible
• cost-share
• copayment
Network providers may not bill the beneficiary for:
• charges that exceed contracted rates
Network Provider Hold Harmless Policy
Payment is not required for any non-covered services except when:
• beneficiary did not inform provider of TRICARE status
• beneficiary informed the services were non-covered, agreed in advance to pay for specific services, and signed TRICARE Waiver of Non-Covered Services
TRICARE Waiver of Non-Covered Services form
• available at UHCMilitaryWest.com > Find A Form
TRICARE Provider Resources
TRICARE West Region Customer Service: 877-988-9378(WEST) - UHCMilitaryWest.com. “TRICARE,” “TRICARE Prime,” “TRICARE Reserve Select,” and “TRICARE Retired Reserve” are registered trademarks
of the Defense Health Agency. All Rights Reserved. This presentation reflects the program as of the date delivered and is subject to change. Administrative guides and the Provider Handbook should be consulted
regarding policies and procedures.
47 Doc#: PCA12480_20140428
Provider Resources – TRICARE
UnitedHealthcare Military & Veterans:
877-988-9378 (WEST)
Extended hours 7 a.m. to 7 p.m. for all time zones
• Have your tax ID number ready when calling
Routine answers for:
• Claims
• Benefits and eligibility
• Contracting
• Provider data updates
TRICARE West Region Customer Service: 877-988-9378(WEST) - UHCMilitaryWest.com. “TRICARE,” “TRICARE Prime,” “TRICARE Reserve Select,” and “TRICARE Retired Reserve” are registered trademarks
of the Defense Health Agency. All Rights Reserved. This presentation reflects the program as of the date delivered and is subject to change. Administrative guides and the Provider Handbook should be consulted
regarding policies and procedures.
48 Doc#: PCA12480_20140428
Provider Resources – TRICARE
UHCMilitaryWest.com
• Network Provider Directory
• TRICARE program updates and UnitedHealthcare Military & Veterans processes
• Link to TRICARE Manuals and policy information
• TRICARE Provider Handbook
• Downloadable forms
• Prior Authorization List
• Secure website information
Check Status of:
• Claims
• Referrals and Authorizations
• Eligibility
Now Submit online:
• Referrals with Episodes of Care
• Authorizations with attachments
:
TRICARE West Region Customer Service: 877-988-9378(WEST) - UHCMilitaryWest.com. “TRICARE,” “TRICARE Prime,” “TRICARE Reserve Select,” and “TRICARE Retired Reserve” are registered trademarks
of the Defense Health Agency. All Rights Reserved. This presentation reflects the program as of the date delivered and is subject to change. Administrative guides and the Provider Handbook should be consulted
regarding policies and procedures.
49 Doc#: PCA12480_20140428
myTRICARE.com Features
Access available to all TRICARE providers
• Network and non-network
• Hospitals, facilities and providers
Resources available (secure site registration required):
• Verify eligibility (including primary care manager, program and other
health insurance information)
• Check referral/authorization status
• Check claim status
• View and print remits
• Pull claim data reports
• Validate provider file demographics
• Validate/submit NPI numbers
• Submit claims via XPressClaim
• Email PGBA directly and confidentially using the “Ask Us” feature
TRICARE West Region Customer Service: 877-988-9378(WEST) - UHCMilitaryWest.com. “TRICARE,” “TRICARE Prime,” “TRICARE Reserve Select,” and “TRICARE Retired Reserve” are registered trademarks
of the Defense Health Agency. All Rights Reserved. This presentation reflects the program as of the date delivered and is subject to change. Administrative guides and the Provider Handbook should be consulted
regarding policies and procedures.
50 Doc#: PCA12480_20140428
myTRICARE.com Features
PGBA website navigation tutorials
mytricare.com > Provider > myTRICARE help > Tutorials • http://www.mytricare.com/internet/tric/tri/mtc_wprov.nsf/sectionmap/myTRCRHlp_VdTtrls
“Ask Us” – secure and confidential email directly to PGBA
Log in to your myTRICARE.com account
• From home page, click on myTRICARE Help/Tools – “Ask Us”
or
• Select a claim and click “Ask Us” at the bottom of page
TRICARE Behavioral Health
TRICARE West Region Customer Service: 877-988-9378(WEST) - UHCMilitaryWest.com. “TRICARE,” “TRICARE Prime,” “TRICARE Reserve Select,” and “TRICARE Retired Reserve” are registered trademarks
of the Defense Health Agency. All Rights Reserved. This presentation reflects the program as of the date delivered and is subject to change. Administrative guides and the Provider Handbook should be consulted
regarding policies and procedures.
52 Doc#: PCA12480_20140428
TRICARE and Behavioral Health
Behavioral Health Program and Resources
UHCMilitaryWest.com > Beneficiaries > Behavioral Health Programs
• General information on topics such as anxiety, depression, autism, PTSD,
substance abuse and suicide prevention
• Behavioral Health Care Services Brochure and Fact Sheet
• Military OneSource
• Live and Work Well
• Quick Links include the Behavioral Health Clinician Search Tool
52
TRICARE Updates and Highlights
TRICARE West Region Customer Service: 877-988-9378(WEST) - UHCMilitaryWest.com. “TRICARE,” “TRICARE Prime,” “TRICARE Reserve Select,” and “TRICARE Retired Reserve” are registered trademarks
of the Defense Health Agency. All Rights Reserved. This presentation reflects the program as of the date delivered and is subject to change. Administrative guides and the Provider Handbook should be consulted
regarding policies and procedures.
54 Doc#: PCA12480_20140428
UnitedHealthcare Military & Veterans Website
Registration Options: Provider or Office Manager
Provider Registration
• Office personnel can register in place of an individual provider
• This option accommodates an unlimited number of registrants
Office Manager Registration
• Office personnel can create one account and add an unlimited
number of provider/professional tax IDs to the account
• There can be multiple Office Manager accounts with the same
provider/professional tax ID
• Both a provider and office manager can register with the same
provider/professional tax ID
TRICARE West Region Customer Service: 877-988-9378(WEST) - UHCMilitaryWest.com. “TRICARE,” “TRICARE Prime,” “TRICARE Reserve Select,” and “TRICARE Retired Reserve” are registered trademarks
of the Defense Health Agency. All Rights Reserved. This presentation reflects the program as of the date delivered and is subject to change. Administrative guides and the Provider Handbook should be consulted
regarding policies and procedures.
55 Doc#: PCA12480_20140428
TRICARE Service Center Walk-In Service Closure
TRICARE Service Center
• Developed 20 years ago to assist beneficiaries with understanding their TRICARE benefit
• Primarily located at Military Treatment Facilities and clinics
Changes
• Beneficiaries increasingly access electronic, internet and toll-free customer service features
• The need for walk-in customer service has decreased and is no longer offered
Quality customer service
TRICARE beneficiaries can manage their benefits and seek assistance:
• 877-988-9378
• UHCMilitaryWest.com
• www.myTRICARE.com
• www.tricare.mil
TRICARE West Region Customer Service: 877-988-9378(WEST) - UHCMilitaryWest.com. “TRICARE,” “TRICARE Prime,” “TRICARE Reserve Select,” and “TRICARE Retired Reserve” are registered trademarks
of the Defense Health Agency. All Rights Reserved. This presentation reflects the program as of the date delivered and is subject to change. Administrative guides and the Provider Handbook should be consulted
regarding policies and procedures.
56 Doc#: PCA12480_20140428
TRICARE and HealthyPeople.gov
UnitedHealthcare Military & Veterans supports the Department of Health and
Human Services’ National Healthy People Program goals of health-promotion and
disease-prevention.
Providers may encourage TRICARE beneficiaries to the “Healthy People”
webpage for health and wellness tips, updates and resources to maintain or adopt
healthy lifestyle habits.
http://www.healthypeople.gov/2020/default.aspx
TRICARE DME Updates and Prescriptions
TRICARE West Region Customer Service: 877-988-9378(WEST) - UHCMilitaryWest.com. “TRICARE,” “TRICARE Prime,” “TRICARE Reserve Select,” and “TRICARE Retired Reserve” are registered trademarks
of the Defense Health Agency. All Rights Reserved. This presentation reflects the program as of the date delivered and is subject to change. Administrative guides and the Provider Handbook should be consulted
regarding policies and procedures.
58 Doc#: PCA12480_20140428
Durable Medical Equipment Changes
Durable Medical Equipment (DME)
Pricing Criteria as of Feb. 15, 2014
DME Information • Detailed DME information can be found at UHCMilitaryWest.com > Providers > Claims >
Durable Medical Equipment Claims Filing Tip Sheet
Authorization is needed for all DME greater than $150
All DME authorization requests must include: • patient’s name
• procedure code(s)
• diagnosis code(s)
• beginning and ending dates equipment is needed
• physician’s statement of prognosis
• valid physician signature – cannot be a certified Nurse Practioner or Physician
Assistant
TRICARE West Region Customer Service: 877-988-9378(WEST) - UHCMilitaryWest.com. “TRICARE,” “TRICARE Prime,” “TRICARE Reserve Select,” and “TRICARE Retired Reserve” are registered trademarks
of the Defense Health Agency. All Rights Reserved. This presentation reflects the program as of the date delivered and is subject to change. Administrative guides and the Provider Handbook should be consulted
regarding policies and procedures.
59 Doc#: PCA12480_20140428
Durable Medical Equipment Changes
Pricing Criteria
Authorizations satisfy Certification of Medical Necessity (CMN)
requirements if DME item costs $150 - $2000 • Exceptions: five items require additional clinical information through submission of the
appropriate CMS form http://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/CMS-Forms-List.html
Proof of Medical Necessity is required for authorization if DME item
costs more than $2000 Be sure to include:
• “required item list” (patient name, diagnosis codes, procedure codes, etc.)
• supporting clinical information justifying the need
CMS
FORM
ITEMS ADDRESSED
484 Oxygen
846 Pneumatic Compression Devices
847 Osteogenesis Stimulators (Bone Growth Stimulators)
848 Transcutaneous Electrical Nerve Stimulators (TENS Units)
849 Seat Lift Mechanisms
TRICARE West Region Customer Service: 877-988-9378(WEST) - UHCMilitaryWest.com. “TRICARE,” “TRICARE Prime,” “TRICARE Reserve Select,” and “TRICARE Retired Reserve” are registered trademarks
of the Defense Health Agency. All Rights Reserved. This presentation reflects the program as of the date delivered and is subject to change. Administrative guides and the Provider Handbook should be consulted
regarding policies and procedures.
60 Doc#: PCA12480_20140428
DME Upgrade When Medically Necessary
DME upgrade is covered when medically necessary if:
• Item otherwise meets the DME benefit requirement
• Prescription specifically states the medical reason why upgrade is
necessary
(e.g. the beneficiary does not have the physical strength or balance
required to lift a standard walker and, therefore, one with wheels is
required)
TRICARE West Region Customer Service: 877-988-9378(WEST) - UHCMilitaryWest.com. “TRICARE,” “TRICARE Prime,” “TRICARE Reserve Select,” and “TRICARE Retired Reserve” are registered trademarks
of the Defense Health Agency. All Rights Reserved. This presentation reflects the program as of the date delivered and is subject to change. Administrative guides and the Provider Handbook should be consulted
regarding policies and procedures.
61 Doc#: PCA12480_20140428
DME Upgrade: Beneficiary Preference
DME upgrade for deluxe, luxury, or immaterial feature device
when it is a beneficiary preference that is not medically
necessary: • TRICARE-allowed amount for base model may be applied to the upgraded equipment if item
otherwise meets DME benefit requirement
• The beneficiary will be solely responsible for the difference between the base model/standard
equipment allowed amount and provider’s billed charges
• Upgrade must be within the range of services appropriate for the medical condition
(e.g.: with no medical objection from physician, beneficiary can upgrade from standard manual
wheelchair to power wheelchair - not from walker to wheelchair)
When a beneficiary prefers to upgrade: Provider may collect charges that exceed the cost the government would pay for the standard
equipment only when:
• Beneficiary is given written notice the upgrade has been (or may be) denied
• Beneficiary agrees in writing to be financially liable for the difference between charges
for the upgraded item and the charges for the standard item
• DME providers need to identify non-payable upgrades to DME using the appropriate
HCPCS/CPT modifiers
TRICARE West Region Customer Service: 877-988-9378(WEST) - UHCMilitaryWest.com. “TRICARE,” “TRICARE Prime,” “TRICARE Reserve Select,” and “TRICARE Retired Reserve” are registered trademarks
of the Defense Health Agency. All Rights Reserved. This presentation reflects the program as of the date delivered and is subject to change. Administrative guides and the Provider Handbook should be consulted
regarding policies and procedures.
62 Doc#: PCA12480_20140428
DME Upgrade Reimbursement
DME item upgraded by beneficiary
• Beneficiary cost-shares and deductible will apply to the basic DME
• Upgrade is not managed by TRICARE but is calculated by the provider/supplier
issuing the equipment
• Upgraded charges and clerical/calculation errors in connection with the
upgraded equipment:
• are not subject to appeal
• are subject to administrative review by UnitedHealthcare Military &
Veterans upon beneficiary request
The upgrade charge is the difference between the provider/supplier charge for the
deluxe or upgraded item and the allowable charge amount for the covered item.
Repairs
Beneficiary is liable for repairs on the upgraded item/features.
TRICARE West Region Customer Service: 877-988-9378(WEST) - UHCMilitaryWest.com. “TRICARE,” “TRICARE Prime,” “TRICARE Reserve Select,” and “TRICARE Retired Reserve” are registered trademarks
of the Defense Health Agency. All Rights Reserved. This presentation reflects the program as of the date delivered and is subject to change. Administrative guides and the Provider Handbook should be consulted
regarding policies and procedures.
63 Doc#: PCA12480_20140428
Prescriptions
Compound Medications
• Effective Feb. 1, 2014, compound medications containing ingredients not approved by the
FDA will no longer be covered by the TRICARE Pharmacy Program
• TRICARE will continue to pay claims for compound medications containing FDA-approved
ingredients
• Details available at www.express-scripts.com/TRICARE
Please encourage beneficiaries to:
• use the MTF as the least expensive option
• suggest the Express Scripts Home Delivery option
Express Scripts mobile app
• Refill, renew, and track prescription orders through TRICARE Pharmacy Home Delivery
• Set medication reminders
• Locate the nearest retail pharmacy
• Search for drug information and more
UnitedHealth Premium® Designation
Program and TRICARE
TRICARE West Region Customer Service: 877-988-9378(WEST) - UHCMilitaryWest.com. “TRICARE,” “TRICARE Prime,” “TRICARE Reserve Select,” and “TRICARE Retired Reserve” are registered trademarks
of the Defense Health Agency. All Rights Reserved. This presentation reflects the program as of the date delivered and is subject to change. Administrative guides and the Provider Handbook should be consulted
regarding policies and procedures.
65 Doc#: PCA12480_20140428
UnitedHealth Premium® Designation Program
To help members make more informed choices about their health care, the
UnitedHealth Premium Designation program recognizes doctors who meet
quality and cost efficiency guidelines. The provider directory identifies
physicians who have met the criteria at UHCMilitaryWest.com.
“Triple Aim”
1. Improve patient experience of care
2. Improve population health
3. Reduce the per capita cost of health care
Doc#: UHC2146v.2_20130725
Better Health Outcomes, Better Care, Lower Cost
TRICARE West Region Customer Service: 877-988-9378(WEST) - UHCMilitaryWest.com. “TRICARE,” “TRICARE Prime,” “TRICARE Reserve Select,” and “TRICARE Retired Reserve” are registered trademarks
of the Defense Health Agency. All Rights Reserved. This presentation reflects the program as of the date delivered and is subject to change. Administrative guides and the Provider Handbook should be consulted
regarding policies and procedures.
66 Doc#: PCA12480_20140428
Military Health System Quadruple Aim
Doc#: UHC2146v.2_20130725
Increased Readiness
• Ensure the total military force is medically ready to
deploy and that the medical force is ready to deliver health care
Better Health
• Reduce frequency of visits by encouraging health behaviors
and focusing on prevention
Better Care
• Provide a care experience that is safe, timely, effective
and patient centric
Lower Cost
• Consider the total cost of care over time and create value by focusing on quality,
eliminating waste and reducing unwarranted variation
(Source: Military Health System Mission, Evaluation of the TRICARE Program FY 2013)
TRICARE West Region Customer Service: 877-988-9378(WEST) - UHCMilitaryWest.com. “TRICARE,” “TRICARE Prime,” “TRICARE Reserve Select,” and “TRICARE Retired Reserve” are registered trademarks
of the Defense Health Agency. All Rights Reserved. This presentation reflects the program as of the date delivered and is subject to change. Administrative guides and the Provider Handbook should be consulted
regarding policies and procedures.
67 Doc#: PCA12480_20140428
Premium Designation Specialties
25 specialties account for more than
80 percent of total health care costs for services delivered
Primary Care Family Medicine Obstetrics & Gynecology
Pediatrics Internal Medicine
Specialists Allergy Orthopaedics-General
Cardiology Orthopaedics-Foot/Ankle
Cardiology-Electrophysiology Orthopaedics-Hand
Cardiology- Interventional Orthopaedics-Hip/Knee
Endocrinology Orthopaedics-Shoulder/Elbow
General Surgery Orthopaedics-Spine
General Surgery–Colon/Rectal Orthopaedics-Sports Medicine
Nephrology Pulmonology
Neurology Rheumatology
Neurosurgery-Spine Urology
Ophthalmology
Premium Designation information is given for physicians who participate with both
UnitedHealthcare commercial health plan networks and TRICARE networks. Information is not
given for physicians who participate only with the TRICARE network.
TRICARE West Region Customer Service: 877-988-9378(WEST) - UHCMilitaryWest.com. “TRICARE,” “TRICARE Prime,” “TRICARE Reserve Select,” and “TRICARE Retired Reserve” are registered trademarks
of the Defense Health Agency. All Rights Reserved. This presentation reflects the program as of the date delivered and is subject to change. Administrative guides and the Provider Handbook should be consulted
regarding policies and procedures.
68 Doc#: PCA12480_20140428
Premium Designation Availability by State
CT
RI
MA
DE
MD
NJ
AL
AR AZ
FL
IA
IL
MO
LA
MI
MS
TN
SC
PA NE
NY
TX
UT
WI
VA
CO
MN
NC
OH IN NV
NM
ND
OK
OR
WA
GA
SD
HI
VT NH
Available
ID
KS
DC
* Illinois: Not available in Southwest Illinois
Michigan: Not available in Upper Michigan
Pennsylvania: Not available Philadelphia
Missouri: Not available in St. Louis, St. Joseph and Jefferson City
Partial Availability*
Not Available
68
ME
AK
CA
WY
MT
Thank You!