Change seems inevitable in the healthcare sphere—especially when it comes to federal healthcare programs. That’s why I wasn’t surprised to hear about the many changes in store for Tricare in 2018. And when it comes to ch-ch-changes, even the starman himself advises you to “turn and face the strange.” Fortunately, we’ll be right there with you, facing those same changes and making sure rehab therapy providers can submit Tricare claims after January 1 without missing a beat. Also, major props are in order for Therabill Support Supervisor Tara Reinert, who combed through these updates, figured out what steps providers and billers would need to take in order to submit claims seamlessly in the new year, and provided us with all of the following information. Thanks, Tara!
Tricare North and Tricare South are merging to become Tricare East.
As of January 1, 2018, Tricare North and Tricare South will be a singular entity known as Tricare East. This change affects all Tricare providers.
What does this mean for providers and practice billers?
Obviously, a change this massive means providers and/or billers who submit claims to Tricare North or Tricare South will have to do a little housekeeping. If you submit claims to either of these entities currently, then you’ll need to take the following actions ASAP:
- In order to submit claims electronically and receive ERAs after January 1, you must complete new EDI and ERA enrollments for Tricare East.
- For all dates of service on or after January 1, 2018, you will need to submit any claims for patients currently under Tricare North or Tricare South to Tricare East. The payer ID for this insurance will be “TREST.”
- Effective January 1, 2018, Tricare North and Tricare South will no longer accept submissions for claims dated December 31, 2017 and prior. You should submit these claims—along with any other claims dated after the new year—to Tricare East.
What’s happening to the existing Tricare East and West contractors?
The contractor for Tricare East is now Humana Military. (You can get more information on this transition in this guide.)
However, the contractor for Tricare West is changing from UHC Military to Health Net Federal Services, so you’ll need to complete a new ERA enrollment if you submit to Tricare West currently. Fortunately, the payer ID for Tricare West (99726) will not change.
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PTAs have the opportunity to treat Tricare patients.
And now for some good news: on December 12, President Trump signed the National Defense Authorization Act, which opens the door for physical therapist assistants to join the Tricare payment program. The APTA has advocated for this change for a long time, so it’s a pretty big win.
That said, this doesn’t mean PTAs are officially open for business with Tricare members. As APTA Senior Congressional Affairs Specialist Michael Hurlbut puts it, “This is a huge step forward for PTAs, but the law itself simply directs DoD to make the change—it will take some time for actual regulations to be created and put in place.” That’s why he recommends PTAs continue checking back with the APTA as the saga unfolds.
In the world of rehab therapy, things can (and do) change constantly, so we highly recommend reaching out to Tricare directly for the most up to date information. After all, the stars may or may not look very different today, but Tricare programs certainly do.