TAKE COMMAND COMMUNICATIONS CAMPAIGN UPDATES TO TRICARE REIMBURSEMENT MANUAL ANNEX DECEMBER 2017

Transcription

1 MILITARY HEALTH SYSTEM COMMUNICATIONS DIVISION TAKE COMMAND COMMUNICATIONS CAMPAIGN UPDATES TO TRICARE REIMBURSEMENT MANUAL ANNEX DECEMBER 2017 MHS Cmmunicatins Divisin Take Cmmand Enrllment Freeze Annex Oct

2 BACKGROUND Several updates have been made t the TRICARE Reimbursement Manual regarding beneficiaries ut f pcket expenses. KEY MESSAGES Updates t TRICARE Select C-Payment Csts The Defense Health Agency (DHA) recalculated cpayment csts fr the TRICARE Select health plan, which will replace TRICARE Standard and Extra n Jan. 1, 2018 due t an errr in the riginal methdlgy. New c-payments are between $3 t $8 lwer than riginally calculated fr multiple types f cpayments. The crrect amunts are listed in the table belw, which updates the figures in the TRICARE Reimbursement Manual, Chapter 2, Sectin 2. TRICARE Select Grup A ADFM Retiree FIGURE Primary Care Outpatient Visits $21 $28 (CY 2018) In-Netwrk FIGURE Specialty Care Visits (CY 2018) $31 $41 In-Netwrk FIGURE ER Visits (CY 2018) In-Netwrk $81 $109 FIGURE UCC Visits (CY 2018) In-Netwrk $21 $28 FIGURE Ambulatry Surgery (CY 2018) $25 N Change In-Netwrk Ambulatry Surgery (CY 2018) N Change Out-Of-Netwrk FIGURE Out Patient Grund Ambulance (CY 2018) In-Netwrk $74 $98 MHS Cmmunicatins Divisin Take Cmmand Enrllment Freeze Annex Oct

3 Clarificatin f Grup A r Grup B Csts Shares fr Certain Beneficiaries If yu re enrlled in TRS, TRR, TYA, r CHCBP, yu have Grup B cst shares accrding t yur spnsr s status (i.e., whether they are an ADFM r a retiree), regardless f when yur spnsr enlisted r was appinted in a Unifrmed Service. If yu re in TRR, yu pay TRICARE Select retiree Grup B cst shares If yu re in TRS, yu pay TRICARE Select ADFM Grup B cst shares If yu re in TYA, yu pay cst shares based n yur spnsr's status (active duty vs. retired) and yur chice f TRICARE Select r TRICARE Prime If yu re in the CHCBP, yu pay TRICARE Select ADFM r retiree csts shares based n their spnsr s status (active duty r retiree) at the time f lss f eligibility If yu re a family member f a freign active duty military member, yu have TRICARE Select Grup B csts shares. Clarificatin f Enrllment Fees fr Medically Retired Retirees, Family Members and Eligible Survivrs f Deceased Active Duty Service Members If yu re a medially retired retiree, family member, r eligible survivr f a deceased active duty service member wh enlisted in r was appinted t a unifrmed service befre Jan. 1., 2018, yur TRICARE Prime enrllment fees are frzen as f the date yu initially enrlled in TRICARE Prime, and remain at that rate until yu elect t disenrll frm r n lnger qualify t be enrlled in TRICARE Prime. Urgent Care Referrals The Directr f the DHA has determined that fr 2018, if yu are a TRICARE Prime enrllee ther than an ADSM, yu d nt need a referral fr urgent care visits, and pint f services charges n lnger apply fr urgent care. If yu re an ADSM r ADFM enrlled in TRICARE Overseas Prgram (TOP) Prime/Prime Remte and seekinig care verseas, yu need an authrizatin frm the TOP cntractr t make sure yur urgent care visit will be cashless and claimless. Withut a prir MHS Cmmunicatins Divisin Take Cmmand Enrllment Freeze Annex Oct

4 authrizatin, an verseas prvider may request payment upfrnt and yu will then have t submit a claim fr reimbursement. The cntractr will prcess the claim with n pint f service charge. If yu re an ADFM enrlled in Prime in the U.S. but traveling verseas, yu need t cntact the TOP cntractr t fr an authrizatin t make sure yur urgent care visit will be cashless and claimless. The cntractr will prcess the claim with n pint f service charge. If yu re an ADSM enrlled in TOP Prime/Prime Remte and are TDY r n leave in the U.S., yu may access urgent care withut a referral r authrizatin. If yu re enrlled in the U.S. but TDY r n leave verseas, yu need t cntact the TOP cntractr t make sure yur urgent care visit will be cashless and claimless. The cntractr will prcess the claim with n pint f service charge. Newbrn Claims Prcessing and Enrllment Newbrns are autmatically enrlled in an apprpriate TRICARE plan when yu register them in DEERS. If yu are ACTIVE DUTY and dn't register yur baby in DEERS within 90 days f birth in the U.S. r 120 days f birth verseas, n day 91/121 yur claims will be denied because yur baby desn't shw as TRICARE eligible. Once yu ve registered yur baby in DEERS (regardless f the number f days frm birth), the baby is autmatically enrlled in in Prime r Select, as apprpriate back t the date f birth, and yu have t ask t have any denied claims reprcessed. Once yu ve enrlled yur baby in Prime/Prime Remte, cverage is backdated t the t the date f birth and yu have t ask t have claims fr care during the first 90/120 days f life that have been denied r Select claims be reprcessed as Prime. If yu are a RETIREE and dn t register yur baby in DEERS within 90/120 days f birth, n day 91/121 yur claims will be denied because the desn t shw as TRICARE eligible. If yu ve registered yur baby in DEERS, (regardless f the number f days frm birth) but haven t enrlled them in a TRICARE plan, yur baby can receive direct care nly and yur netwrk claims will be denied. MHS Cmmunicatins Divisin Take Cmmand Enrllment Freeze Annex Oct

5 If yu register yur baby in DEERS and enrll them in Prime/Prime Remte/Select, as applicable, within 90 days f birth, the baby s cverage is backdated t the t the date f birth and yu have t ask t have claims fr care during the first 90/120 days f life that have been denied reprcessed. In 2018, yu can enrll at any time. In 2019, yu will have t wait fr a Qualifying Life Event (QLE) r the annual Open Enrllment Seasn. Fr claims fr care fr newbrns, nce yur baby is shwn as enrlled in a TRICARE plan in DEERS, they are n lnger treated as if they re enrlled in TRICARE Prime r Select fr cst sharing f claims fr up t 90 days (120 days if verseas) as in the past. Claims fr yur baby s care received after the date yu enrlled them will be prcessed accrding t the cst sharing prvisins f their enrlled plan. Beginning Jan. 1, 2018, if yu re an ADFM f a new accessin and new family members f ADSMs residing in an verseas area, yu re autmatically enrlled in TOP Select and have up t 90 days t change yur enrllment t TOP Prime r TOP Prime Remte. FOR MORE INFORMATION Fr questins regarding the Take Cmmand cmmunicatins campaign r this Manual Changes and Clarificatins annex, please cntact Mr. Paul Fitzpatrick at paul.m.fitzpatrick2.civ@mail.mil r Virginia White at virginia.l.white33.ctr@mail.mil. MHS Cmmunicatins Divisin Take Cmmand Enrllment Freeze Annex Oct