July 24, 2018
Area(s) of Interest: Payor Contracting Payor Issues and Reimbursement Practice Management
On January 1, 2018, Health Net Federal Services (HNFS) became the new Defense Heath Agency (DHA) managed care contractor for the TRICARE West Region, serving approximately 2.9 million beneficiaries in 21 western states, including California. HNFS took over the contract previously held by UnitedHealthcare Military and Veterans’ Services (UMVS). The California Medical Association (CMA) has learned that HNFS has experienced implementation issues related to provider contracting and credentialing, beneficiary reassignment to new primary care managers (PCM), and provider directory inaccuracies.
The contracting and credentialing issues in California are reportedly related to problems with HNFS staffing turnover and include the following:
- Completed provider contracts that were not entered into the HNFS system
- HNFS unable to locate countersigned provider contracts
- Cases where the contracting or credentialing processes were never completed
HNFS shared in recent discussions with CMA that it has identified the providers impacted by the breakdowns and is actively working to expedite completion of the credentialing and contracting processes.
Additionally, CMA has learned that as part of the TRICARE transition, DHA allowed TRICARE Prime beneficiaries to receive care from PCMs previously in the UMVS network that were not yet in the HNFS network, without incurring out-of-network fees through June 30. The purpose was to allow HNFS additional time to contract with providers and develop its provider network.
When the transition ended, approximately 44,000 California enrollees assigned to 3,800 out-of-network PCMs were reassigned to network PCMs (which includes physicians, nurse practitioners and physician assistants). Although HNFS published information about the end of the transition period in its online provider bulletins, the payor did not directly notify the 3,800 PCMs that their TRICARE Prime patients were being reassigned.
HNFS is also experiencing significant provider directory accuracy issues. To address this issue, HNFS has partnered with its parent company, Centene, and LexisNexis to improve the accuracy of its provider directory and expects improvements over the next 30-120 days.
What Can Physicians Do?
Questions about contract status? Physicians with questions about their contracting and/or credentialing status with HNFS can check the HNFS credentialing status tool at www.tricare-west.com. For additional information, contact Megan Herrera, Director of HNFS Provider Network Management, at (619) 285-3607 or email@example.com.
Affected by patient reassignment? Physicians affected by the reassignment of patients to a HNFS network PCM who are interested in participating in the HNFS provider network can contact Megan Herrera with HNFS at (619) 285-3607 or firstname.lastname@example.org. Once the contracting and credentialing process has been completed, HNFS reports that during July and August it will reassign the affected enrollees back to the original PCM. For more information on PCM reassignments, visit the HNFS Tricare West website.
Provider directory: Practices are also encouraged to check HNFS’ online provider directory to confirm participation status and demographic information. If demographic updates are needed, physicians can submit updates via HNFS’ online tool. If the directory does not accurately reflect participation status, contact Megan Herrera at (619) 285-3607 or email@example.com.
For more information on the West Region transition issues, see the HNFS FAQ.
CMA is working with HNFS to ensure these issues are resolved quickly and adequately. Physicians with questions or concerns can contact HNFS directly at (844) 866-9378 or CMA’s Center for Economic Services at (888) 401-5911.