TRICARE Addresses Backlog Issue

TRICARE, the armed forces’ managed health-care plan for service members, retirees and dependents, is taking steps to resolve issues in its West Region that emerged since the Defense Health Agency implemented changes to the program on Jan. 1.

Beneficiaries covered through TRICARE’s West Region have since been beleaguered by long waits for responses at its call centers, processing backlogs, and a limited number of providers in its directory.
TRICARE announced Feb. 22 that Health Net Federal Services (HNFS), its contracting partner for the West Region, has made announcements and taken several steps to help alleviate the problems. Among them:

* Medically urgent requests will get priority, while the agency works to resolve the backlog issue. Meanwhile, the Defense Health Agency is waiving an authorization requirement, which would allow beneficiaries to seek outpatient coverage more quickly. Doing so requires downloading a referral and authorization letter before seeking care covered by TRICARE. Some procedures, such as applied behavior analysis, laboratory developed test and Extended Health Care Option services, still require prior authorization. TRICARE and HNFS also are working with providers to extend operating hours.
* While the agency works to resolve call center waits, beneficiaries are encouraged to use self-service options available at https://www.tricare-west.com.

* A three-week freeze in enrollment that took place in December caused the current backlog problem, which the agency and contractor are trying to resolve. In the meantime, beneficiaries enrolled in TRICARE Prime can see providers who are not in the HNFS network through March 31, without incurring point-of-service charges — as long as they have not already been assigned a primary care manager. TRICARE Select beneficiaries can see any authorized TRICARE provider in or out of the network. The provider’s network status would determine how much beneficiaries would have to pay out of pocket. Beneficiaries should check their status on milConnect, or at https://www.tricare-west.com, for self-service options.

* HNFS said it is taking steps to provide a complete and accurate directory of providers. Gathering and updating such information, however, depends upon cooperation from the providers themselves.