Tricare still source of frustration

AAHomecare suggests working complaints up the chain
 - 
Friday, June 21, 2019

SAVANNAH, Ga. – More than a year after Humana Military took over the Tricare East contract, there are still billing issues, providers report.

Provider David McLeod, for example, has been told he must submit a certificate of medical necessity every time he submits a claim for a CPAP device because the claims processor doesn’t have the ability to attach a CMN already on file.

“Essentially they are saying that, for us to get paid, we have to go through the whole process of submitting paperwork for each claim,” said McLeod, owner of Savannah, Ga.-based SleepWell. “It’s onerous and unprecedented.”

Humana Military outsourced the billing to Wisconsin Physician Services when it took over the Tricare East contract from Health Net Services on Jan. 1, 2018. At that time, Tricare consolidated from three to two regions, East and West. Since then, providers have reported getting paid slowly, incorrectly or not at all, as well as difficulty communicating with Humana.

McLeod filed a complaint with the local insurance commissioner, to no avail.

“We’re a fairly small company,” he said. “We really don’t know what to do. We are considering dropping Tricare.”

Laura Williard, vice president of payer relations for AAHomecare, recommends providers file a formal grievance with Humana, which has 30 days to respond. If they don’t get a response, they should summarize their issues and send it by mail to the Defense Health Agency, which oversees the Tricare contract.

“We’ve filed multiple letters of concern with the agency and we are asking that providers start making these complaints,” she said. “Maybe this will get a little more attention for this issue and they will fix the claims processing. I think that’s really where the issues are.”

Provider Chris Smythe says things have improved somewhat since his accounts receivables with Tricare hit an all-time high in November 2018.

“We’ve been able to work with them to reduce that by close to 50%,” said Smith, vice president at Tycon Medical, which has locations in Norfolk and Portsmouth, Va. “We are still having some specific issues and getting strange requests to provide CMNs for patients that already have the CMN in the system.”