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Changes to TRICARE in 2018

January 1st, 2018, was the beginning of the new TRICARE program which saw quite a few changes from its previous iteration. The separate North and South regions were combined into a single “East” region. Additionally, new contractors were chosen to administer the health care plans:

  • Families in the West Region will receive coverage from Health Net Federal Services, LLC.
  • Families in the new East Region will receive coverage from Humana Military.

These changes to managed care support contractors mean it is vital for ABA therapy providers to familiarize themselves with any new processes that may have occurred.  Being well informed will ensure that you are able to provide the best quality ABA therapy care to active and retired military service members and their families.

At Amvik Solutions, we are ready to help ABA therapy service providers and clinics to transition into the new year. If you are TRICARE West ABA therapy health care provider consider the following information:

Tricare West – Health Net Federal Services (HNFS)

    1. The Tricare West website – – is now available as of Jan 1st, 2018. The website features a number of tools necessary to deliver services including the ability to: check patient eligibility, submit claims, review referral and authorization requirements, submit requests for services (check status), notify Tricare West of hospital admissions, update demographics, sign-up for electronic funds transfer (EFT) and electronic remittance advice (ERA), print out quick reference charts, view webinar schedules, read FAQs, download the HNFS TRICARE West Region Provider Handbook, and much more.
    2. Major changes to the TRICARE program:
      • TRICARE Select has replaced TRICARE Standard and Extra. TRICARE Select is a self-managed, preferred provider network plan.
      • Beneficiary copayments and cost-shares are based on plan type and sponsor’s military status, and possible the sponsor’s enlistment/appointment date. Beneficiaries are being categorized as “Group A” and “Group B”.
      • Benefit enhancements including the removal of referral requirements for TRICARE Prime beneficiaries seeking urgent care; expanded preventative services benefits for TRICARE Select beneficiaries who see network providers; coverage of medically necessary foods and vitamins with those with metabolic disorders.
    3. Health Net Federal Services began accepting referral and authorization requests, as well as claims, on January 1st, 2018. Network providers are required to use the HNFS online prior authorization and referral tools for all approval requests, and must submit claims electronically.

Exception: Network providers in Alaska are not required to submit electronic claims.

  1. HNFS will honor referrals and authorizations issued by UnitedHealthcare Military & Veterans through their expiration dates. Online authorization status tools will include active referrals and authorizations issued by UnitedHealthcare that have an end date that extends beyond Jan. 1st, 2018.
  2. The Where to Submit Claims guide is a valuable resource for providers. The TRICARE West Region electronic claims payer ID is still the same: 99726.

Please visit the TRICARE West For Providers website for additional information, resources, sign-in portal, claims submission options, and much more.

Tricare East – Humana Military

  1. The Tricare East website – – remains available for health care providers to: learn about TRICARE programs and coverage, access provider forms, learn about education opportunities, get billing guidelines, access handbooks and manuals, submit claims, verify patient eligibility, look up codes, update referral and authorization requests. Some tools may require registration.
  2. Wisconsin Physicians Service (WPS) is the new fiscal intermediary that will be conducting claims processing for the new East Region. WPS requires that all electronic providers/groups sign, and have on file, a Trading Partner Claims Agreement (“Agreement”) prior to the submission of electronic claims. Additionally, all providers that submit EDI claims directly to WPS need to complete a self-registration process.
  3. Any carry-over referrals and authorizations approved prior to December 31st, 2017 will remain valid in 2018.
  4. TRICARE Select has replaced TRICARE Standard and Extra. TRICARE Select is a self-managed, preferred provider network plan.

Please visit the TRICARE East website for providers to find additional information, resources, sign-in portal, claims submission options, and much more.

Stayed informed all throughout 2018 with Amvik Solutions. We have the tools and experience to help support you in your role as an ABA therapy provider to America’s military families.

Our understanding of medical billing, practice management software, and more can provide you the help you need to run a successful ABA practice. We also offer a number of services to increase your patient-load and receive payment for claims so you can continue to provide meaningful and quality ABA services.

Contact us today at (805) 277-3392 to find out more about our services.