February 07, 2018
Area(s) of Interest: Payor Issues and Reimbursement
On January 1, 2018, Health Net Federal Services (HNFS) began providing managed care services to 2.9 million TRICARE beneficiaries in the 21 western states, including California. During the first month of the transition, there were few reports of issues with the new TRICARE West Region contractor.
HNFS has advised that callers to its customer service call centers may experience longer than average hold times due to heavy call volumes. The California Medical Association (CMA) has received a number of reports from physicians of delays in the authorization approval process similar to those experienced during the prior TRICARE transition to UnitedHealthcare Military and Veterans Services (UMVS). During that transition, physicians reported significant delays in processing of authorizations and referral requests, long hold times, website problems and difficulty registering for secured access to the UMVS portal.
HNFS has advised that it will honor referrals and authorizations issued by UMVS through their 2018 expiration dates, even if the servicing provider is not a part of the HNFS West Region network. HNFS will issue authorization letters for services for dates of service on or after January 1, 2018. Providers seeking to determine whether a procedure or service requires prior authorization, referral or is a covered benefit can utilize the HNFS Prior Authorization, Referral & Benefit Tool, located on the HNFS website.
Physicians with questions regarding the TRICARE transition may contact HNFS at HNFSProvRel@healthnet.com.
HNFS has put together an FAQ document and CMA has prepared a TRICARE transition guide to help physicians understand the impact the transition will have on their practices. CMA is also working with HNFS to obtain clarity on the reported delays.
Questions: CMA’s reimbursement helpline, (888) 401-5911.