NEW! Annual Pricing Updates: The following claim types are subject to the latest rate updates beginning with discharge dates of service on and after October 1, 2016: DRG, OPPS, RTC, PHP and Inpatient Mental Health. These claims will be held temporarily until pricing updates are received from DHA. We expect the affected facility claims to be released by mid-November. We apologize for any inconvenience and thank you for your patience.
Web Protocol: myTRICARE will only accept internet traffic via the secure TLS 1.1 and TLS 1.2 protocols. If you are having issues accessing myTRICARE Secure, verify that your browser settings have TLS 1.1 and TLS 1.2 enabled.
Urgent Care Clinics: Eligible TRICARE Prime beneficiaries can obtain urgent care twice per fiscal year from an authorized provider without a referral under the Urgent Care Pilot Program.
Autism Care Demonstration (ACD): Check out the latest update to the ACD program.
Breast Pump Policy Update: TRICARE policy has been updated to include the coverage of breast pumps and supplies and breastfeeding counseling, effective July 1, 2015.
Air Ambulance Services: Air ambulance services on or after October 1, 2014, shall be paid the greater of the Medicare AFS or the TRICARE provisional air ambulance CMAC. For the initial transition period of October 1, 2014 through December 31, 2015, the TRICARE provisional air ambulance CMAC shall be calculated as 85% of the base year rate established under TRICARE Reimbursement Manual paragraph 126.96.36.199.
Consultations and Follow-Up Reports: Consult reporting is an essential step to facilitate appropriate continuity of care for all TRICARE beneficiaries. Learn more about submitting consult reports.
Outpatient Prospective Payment System (OPPS): Centers for Medicare & Medicaid Services (CMS) implements quarterly updates to OPPS. Information related to the July 2016 update is available directly from CMS. Please note: Medicare specific coding requirements must be followed (with the exception of DHA developed APCs) in order to receive TRICARE reimbursement under the OPPS.
Performance: check out the West Region Report Card!
ALERT! EDI Submitters: Prevent your TRICARE claims from rejecting with the Invalid Member ID (H65) edit.
Our Prime Partner
Click here to go to our Prime Contracting Partner's website to find other helpful tools.