May 22, 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 a number of reports from physician practices that are experiencing various difficulties.
In an effort to understand the problems, CMA conducted a survey in mid-April and found widespread reports of difficulties including contracting problems, delays in processing of authorizations and referral requests, long hold times and website problems.
Among the survey findings:
- Almost three out of four respondents indicated they experienced various difficulties with the transition to UMVS, 42 percent of them indicating that those problems had a negative impact on patient care.
- Many physicians reported significant delays in processing authorization and referral requests that negatively affected patient care, as many were forced to reschedule patients or were unable to make referrals to specialist. (In fact, these problems are so pervasive that the Department of Defense has issued a temporary waiver for TRICARE authorizations and referrals through June 18. Physicians will not, during that time, be required to seek or wait for an approval from UMVS for any covered services.)
The survey gathered data from 321 practices representing physicians from over 27 different specialties in 31 different counties within California over a period of five business days. For more details, see CMA's TRICARE Transition Survey Summary.
For more information on the TRICARE transition, see CMA's TRICARE Transition Guide, available free to members in the CMA store.
Physicians who continue to experience problems with TRICARE are encouraged to contact CMA at (800) 401-5911 or firstname.lastname@example.org.