TRICARE Update: New Regions Effective January 1st
Effective January 1, 2018, the TRICARE regional configuration changed. These changes affect the provider enrollment process.
The three former TRICARE regions have become two. The former north and south regions have merged into a new, singular "East Region." This region will be managed by Humana Government Business (Humana Military). The mostly unchanged West region will be managed by Health Net Federal Services, LLC (HNFS).
In a related change, beneficiaries of Lubbock and Amarillo, Texas, who were formerly in the South region, will move into the TRICARE West region. However, PPO Certifications are handled through WPS (Wisconsin Physician Services) regardless of which region you fall under.
According to Health.mil, the 2-region concept reduces administrative variation across regions and reduces administrative cost while providing seamless support to a mobile TRICARE beneficiary population.
If you are a civilian provider for TRICARE patients, you have 2 options for reimbursement for treating members:
- Becoming a certified provider will allow you to bill and receive Medicare level reimbursement for services. Certified-only providers are "out of network." OR
- Go through credentialing and contracting with - depending on your location - either Humana Military or HNFS. This way your practice will have an in-network participation contract.
TRICARE has a "right of first refusal (ROFR)" in deciding where members are treated. Beneficiaries of TRICARE may be referred to civilian providers only after the local military clinic or hospital makes a determination as to whether or not they can provide services.
TRICARE Region Change Transition Resources
Humana Military Providers - Getting Started
TRICARE West Region Transition: Frequently Asked Questions
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If you require medical credentialing and payer enrollment needs for your practice or medical facility, please contact 1st Assistant. Our experienced and dedicated specialists will provide all credentialing and enrollment services quickly and will monitor your account for ongoing updates and re-attestations. Heidi Henderson, our company owner and President, is eager to meet you and discuss your payer enrollment needs. Please call us at 512.201.2668 or contact us via the website.