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Physicians report significant difficulties with TRICARE transition



April 11, 2013

Since the transition of TRICARE managed care services from TriWest to UnitedHealth Military and Veterans Services on (UMVS) on April 1, 2013, the California Medical Association (CMA) has received reports from physician practices that are experiencing various difficulties including, significant delays in processing of authorizations and referral requests, long hold times, website problems, difficulty registering for secured access to the UMVS portal and contracting problems.


To help assess the severity of the situation, CMA conducted a brief survey to help identify areas of concern, escalate those issues to UMVS and ensure the problems are addressed and resolved quickly.


The survey results confirm that the TRICARE transition to UMVS has been problematic in its first weeks. The most common complaints were with website problems (35 percent), delays in authorization and referral requests (30 percent) and long hold times (30 percent) when calling to seek resolution. Many practices (42 percent) reported that the issues they’ve experienced with the transition have had a negative impact on patient care.


CMA met with high level UMVS representatives on April 12 to discuss these concerns. During the meeting, UMVS did acknowledge delays with call hold times in the early days of the transition. To address this issue, they have since added additional staff to the phone lines to help reduce wait times. Practices that are still experiencing long hold times are encouraged to contact CMA and share your experience.


During the meeting, UMVS also acknowledged delays in the processing of authorization and referral requests. To address the delays, UMVS has reallocated staff and committed by April 17 to be processing urgent authorization and referral requests within two business days and by April 24 to be processing routine requests within five business days. Practices who are not receiving responses to authorization or referral requests within these timeframes by the above dates are encouraged to let CMA know. Please note, however, UMVS advised CMA that while responses to urgent requests will be faxed to the practice, responses to routine requests are currently being mailed. CMA has raised concern that mailing responses only contributes further to the delays and has recommended that UMVS maintain the same fax process for both.


In order to access eligibility and benefits, authorization and referral forms, claim status, etc. users must first register on the UMVS website. However, many practices reported they had difficulty registering for the secured portal on the UMVS website. UVMS identified and fixed a technical problem that was causing many of the registration problems. Since the fix was implemented on April 9, UMVS reports a significant increase in registered users.


Some practices had also reported that the website limited them to one authorized user. However, UMVS has confirmed that office managers can have multiple authorized users per physician. Practices who are still unable to register multiple users should contact UMVS for assistance.


Additionally, CMA asked UVMS for clarification regarding concerns we previously raised with certain provisions of the UMVS contract. According to UMVS, a contract amendment was recently sent to physicians that addressed many of our concerns. CMA has asked UMVS for a copy of the amendment or written confirmation of the changes. CMA has not yet, however, received either.


United Healthcare is also hosting a series of webinars covering TRICARE eligibility, programs, clinical programs, provider types and access, referrals and authorizations, claims and reimbursement and provider resources. The next webinar will be held Wednesday, April 24. Click here for more information.


If you are unable to attend the live webinars, there is an on-demand TRICARE webinar on the www.uhcmilitarywest.com portal, "TRICARE Basics for Medical/Surgical Professionals, Facility, and Ancillary Providers." To access the recorded presentation, click on "Provider" then on "Provider Education."


Physicians who have questions can contact UMVS at (877) 988-9378.


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