TRICARE Health Benefits

TRICARE Health Benefits

TRICARE is managed by the Defense Health Agency (DHA) under the policy guidance and direction of the Assistant Secretary of Defense (Health Affairs) (ASD[HA]). The DHA manages the TRICARE budget, executes TRICARE policies and oversees the entire TRICARE health program.

As a major component of the Military Health System, the TRICARE health program combines the health care resources at military hospitals and clinics (or direct care) with networks of civilian health care professionals, institutions, pharmacies and suppliers to provide access to high-quality health care services while maintaining the capability to support military operations.

TRICARE partners with Health Net Federal Services as its regional contractor in the Western United States to provide health care services and support to beneficiaries.

Important Website Links

My TRICARE Health Benefits
My TRICARE Dental Benefits
TRICARE Pharmacy Benefits

TRICARE West Region Contract Transition
Frequently Asked Questions For Beneficiaries
Effective Jan. 2018

We are honored to serve the military service members, retirees and their families in the TRICARE West Region. On Jan. 1, 2018, the TRICARE West Region contract is transitioning to a new managed care contractor, Health Net Federal Services, LLC (HNFS). In partnership with the Defense Health Agency and HNFS, it is our goal to ensure the TRICARE contract transition is seamless for TRICARE beneficiaries. We have prepared some Frequently Asked Questions to help you through the transition period. We will update the Frequently Asked Questions as more information is available. For general information regarding the TRICARE contract transition, please visit: www.tricare.mil/changes

Important Date Topic Contract
Dec. 31, 2017
  • Last day to submit a care request to UnitedHealthcare Military & Veterans. Referrals and authorizations for care requests received up until Dec 31, 2017 will be processed by UnitedHealthcare Military & Veterans.
  • Last day to access your UHCMilitaryWest.com account.

UnitedHealthcare Military & Veterans myTRICARE.com will continue to be available for account information and claims submission through April 30, 2018
Jan. 1, 2018
  • All referrals and prior authorizations
  • Claims with dates of service on or after Jan. 1, 2018
  • Benefit information
  • Billing and Enrollment Information
  • You may continue to contact UnitedHealthcare Military & Veterans for status of claims for care with a date of service on or before Dec. 31, 2017.

Health Net Federal Services (HNFS) www.tricare-west.com

UnitedHealthcare Military & Veterans myTRICARE.com; 877-988-9378
March 31, 2018
  • Last day to call UnitedHealthcare Military & Veterans customer service for status of claims for care with a date of service on or before Dec. 31, 2017.

UnitedHealthcare Military & Veterans 877-988-9378
April 30, 2018
  • Last day to submit claims with a date of service on or before Dec. 31, 2017 using myTRICARE.com.
  • Last day to submit appeals for claims with a date of service on or before Dec. 31, 2017.

myTRICARE.com;
UnitedHealthcare Military & Veterans
May 1, 2018
  • All TRICARE inquiries, regardless of date of service

Health Net Federal Services (HNFS) www.tricare-west.com

Referrals Management & Beneficiary Care Satisfaction

I have an authorization/referral for care from UnitedHealthcare Military & Veterans. Can I still use it after the contractor changes on January 1, 2018?

Yes. If you have an authorization or referral that was approved for care beyond December 31, 2017, HNFS will honor it. If you have any questions about a referral or authorization after December 31, 2017, please contact HNFS for the most current information.

How long is my referral/authorization approved for?

Please refer to your approval letter. The end date of the approval is the date that your referral/authorization is valid through.

Can I still see the provider listed on my approved referral or authorization after December 31, 2017?

HNFS will honor all referral and authorizations approved by UnitedHealthcare Military & Veterans (UnitedHealthcare). After December 31, 2017, if you have a question regarding a specific provider you should contact HNFS.

How do I change the provider listed on my approved authorization/referral?

It may be possible to change the provider on an approved authorization/referral if services have not yet been rendered:

Before January 1, 2018: Please contact UnitedHealthcare Military & Veterans at 877-988-9378.

On or after January 1, 2018: Please contact HNFS.

I have an approved referral/authorization from UnitedHealthcare Military & Veterans for durable medical equipment (DME). What happens if I don’t get the equipment until after December 31, 2017 when HNFS is the new contractor? Will a new referral be needed?

HNFS will honor all referrals and authorizations that were approved by UnitedHealthcare Military & Veterans prior to January 1, 2018 unless they are modified or canceled. If you have questions after January 1, 2018, please contact HNFS for the most current information on the status of a referral/authorization.

How will my authorization be handled if I am an in-patient receiving care prior to and beyond January 1, 2018?

UnitedHealthcare Military & Veterans will approve your authorization for inpatient stay through a pre-determined end date. If your inpatient stay needs to be extended beyond that date, HNFS will provide the necessary authorization for additional inpatient days.

Case Management

I am a TRICARE beneficiary with a UnitedHealthcare Military & Veterans case manager. What will happen after December 31, 2017, will I be assigned a new case manager by HNFS?

All cases will be managed in coordination with HNFS at least 60 days prior to December 31, 2017 to ensure continuity of care.

All active cases will be transitioned to HNFS after December 31, 2017. If you are enrolled in a case management program and are assigned a case manager and have questions after December 31, 2017, please contact HNFS.

Appeals & Grievances

I am a beneficiary and I have an open appeal with *UnitedHealthcare Military & Veterans. After December 31, 2017, who do I contact if I have questions?

Appeals for claims with dates of service before January 1, 2018:

If the appeal is received before April 30, 2018, it will be processed by UnitedHealthcare Military & Veterans.

You can contact UnitedHealthcare Military & Veterans for status on an appeal through March 31, 2018. If you have a question after March 31, 2018 for an appeal on a claim with a date of service before January 1, 2018, you will need to contact HNFS.

Enrollment

Where should I send my enrollment application prior to January 1, 2018?

Enrollment applications with an effective date on or before December 31, 2017: Send applications to UnitedHealthcare Military & Veterans.

Enrollment applications with an effective date on or after January 1, 2018: Send applications to HNFS.

Will I have to update/change anything in DEERS during the TRICARE West Region transition?

You only need to update DEERS if you have a change to your family, address or phone number, however, it’s always a good idea to review and make sure your DEERS information is current.

If I submitted a reinstatement request to UnitedHealthcare Military & Veterans before December 31, 2017, what happens after December 31, 2017?

UnitedHealthcare Military & Veterans will review your reinstatement request and coordinate your request directly with HNFS if needed.

Billing

Do I need to do anything to end my recurring payments with UnitedHealthcare Military & Veterans after December 31, 2017?

Your automatic premium payments set up with UnitedHealthcare Military & Veterans will automatically end as of December 31, 2017. You will need to re-establish your automatic payment with HNFS for payments on/after January 1, 2018.

What happens to any premium payments I made to UnitedHealthcare Military & Veterans on my account that should apply after December 31, 2017?

The payments will automatically be applied to your account with the new TRICARE West Region contractor. However, you will need to re-establish your automatic payment with HNFS for any payments on/after January 1, 2018.

Claims

After December 31, 2017, to whom do I submit a claim for care I received before January 1, 2018?

Claims with dates of service before January 1, 2018 should be sent to UnitedHealthcare Military & Veterans through April 30, 2018.

Claims submitted after April 30, 2018, regardless of the date you received care, should be sent to HNFS.

If I have a referral from UnitedHealthcare Military & Veterans but I received service after December 31, 2017, who will pay my claim?

For details regarding claim payments for care received after December 31, 2017, please contact HNFS.

Privacy

I have an authorization to disclose and/or other legal documents and restrictions in place with UnitedHealthcare Military & Veterans. Will these types of requests and legal documents be carried over to HNFS?

HNFS will review and process active restrictions, authorizations to disclose and other legal documents previously submitted to UnitedHealthcare Military & Veterans. However, not all requests and legal documents are transferable to HNFS. The HNFS Privacy Compliance Office strongly recommends beneficiaries call HNFS on or after Jan. 1, 2018, to confirm appropriate restrictions and documents are in place. Should you need to resubmit a privacy request to HNFS, you will be able to access forms and submission instructions at www.tricare-west.com.


Important Phone Numbers

TRICARE Regional Appointment Center(TRAC): (800) 404-4506
Health Net Federal Services: (844) 866-9378
Madigan Army Medical Center Referral Coordination Center: (253) 968-2903
Nurse Advice Line (always open): (800) TRICARE (874-2273)
Appointment Line: (800) 404-4506
Beneficiary Counseling and Assistance Coordinators:

Appointment Line Hours

Monday-Friday: 6:00 a.m. - 8:00 p.m.
Saturday and Sunday: 7:00 a.m. - 3:30 p.m.
Closed on Federal Holidays

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