Practice Management

Is anyone experiencing the nightmare with Healthnet for Tricare West when trying to obtain a referral or authorization?

We have been told by representatives that they are waiving any Point of Service costs for members through March 31, 2018 but they cannot point us to anywhere that we can find this in writing or provide it to us in writing.

If anyone can direct me to where I can find this in writing or provide a good direct contact person at HealthNet that can verify this for us, that would be great.  I am currently on an estimated 30 minute hold time just to get to a customer service rep who probably won't be able to help me anyway.

Thank you,

Jenny Mauro

Revenue Integrity Analyst

PENRAD Imaging and Colorado Springs Radiologists

719-265-3771

Here's the link and the info as well:  https://www.tricare-west.com/content/hnfs/home/tw/prov/res/provider_news/transition-of-authorizations.html 

Transition of TRICARE West Region Authorizations

Sunday, January 21, 2018

As the new contractor for the TRICARE West Region effective Jan. 1, 2018, Health Net Federal Services, LLC (HNFS) will honor referrals and authorizations issued by UnitedHealthcare Military & Veterans (UnitedHealthcare) through their 2018 expiration dates, even if the servicing provider is not part of the HNFS West Region network. This is a requirement per the terms of our TRICARE contract award, and we ask you please not delay beneficiary care.

You do not need a separate approval letter from HNFS. We are only issuing new authorization letters for services approved on or after Jan. 1, 2018. Use our online authorization and referral tools at www.tricare-west.com to view current approval status. Additionally, UnitedHealthcare will maintain information at www.myTRICARE.com through June 30, 2018, although the option to print previously issued approval letters is no longer available.

No action is required by you. We've completed loading active UnitedHealthcare authorizations into our systems for accurate claims processing.

Beneficiaries will not be charged Point of Service. TRICARE Prime beneficiaries will not be charged Point of Service costs if the servicing provider on an active UnitedHealthcare approval is not in our HNFS West Region network. (Beneficiaries who choose to see a different non-network civilian provider than the one authorized by UnitedHealthcare will be charged Point of Service after March 31, 2018.)

Most beneficiaries no longer require a referral for urgent care. Effective Jan. 1, 2018, beneficiaries other than active duty service members enrolled in TRICARE Prime can seek urgent care from network or non-network urgent care provider types without a referral and without visit limits. (Active duty service members, except those enrolled in TRICARE Prime Remote, still require a referral for all civilian urgent care services.)

Thank you for using our online tools. To date, we've received over 19,000 online referral or authorization requests! Thank you for complying with our requirement to submit online. As a reminder, when requesting a specific provider, you must include his or her first and last name, and address. Additionally, be sure to complete all required fields to expedite processing.