It is simple math. Over the past 12 years more than 2 million service members have deployed, many multiple times, and some studies suggest that at least 30% of these warriors will have some psychological health concern or traumatic brain injury. That means potentially 600,000 service personnel who could benefit from some type of behavioral health service. Add to that almost 2 family members for every service member, who have also endured multiple deployments and the math becomes clear. The needs of warriors and their families far outstrip the ability of the military and veteran behavioral health services to provide timely access to quality care.
So how can we balance the equation and decrease the access deficit? One way is for you, providers in the community, to become TRICARE providers. So today we will explore the nuts and bolts of becoming a TRICARE provider with some Q&A with representatives from TRICARE North Region’s contractor, Health Net Federal Services, LLC.
"It's a chance for behavioral health providers to serve our country"
If you previously considered becoming a TRICARE provider or feel inspired to explore the option now, we hope that this information will help you to take action. CDP is committed to providing training for providers to increase competence and comfort with treating deployment related behavioral health problems, but we need you, those providers, to then address the access deficit by serving those who have served. We can balance the equation and avoid a behavioral health crisis in our communities. Be a part of the solution and help balance the equation… even if you don’t like math.
Q: Who is enrolled in TRICARE?
A: TRICARE is available worldwide to eligible beneficiaries, including active duty service members and their families, retired service members and their families, National Guard and Reserve members and their families, survivors, certain former spouses and others, from any of the seven uniformed services: the U.S. Army, U.S. Navy, U.S. Air Force, U.S. Marine Corps, U.S. Coast Guard, the Commissioned Corps of the U.S. Public Health Service and the Commissioned Corps of the National Oceanic and Atmospheric Administration (NOAA).
Q: Currently how many health care providers accept TRICARE? How many behavioral health care providers?
A: TRICARE counts just over 180,000 unique (individual) contracted network providers in the TRICARE North Region. Of that number, there are 22,500 behavioral health network professionals and 392 network behavioral health facilities. In addition to the contracted network providers, there are tens of thousands of non-network providers that render care to TRICARE beneficiaries. Non-network providers can change on a patient-by-patient basis whether they will see a TRICARE beneficiary.
Q: What is the general process for becoming a TRICARE provider for behavioral health practitioners?
A: To be considered for becoming a TRICARE provider, the best action is to call 1-877-TRICARE and inquire with a Health Net customer service representative. If needed, the provider will be sent a contract and a credentialing application. If not, TRICARE and Health Net hope that the provider will participate on a non-network provider basis, and will check back in six months to a year to see if network participation is needed at that time.
TRICARE is divided geographically into regions. For those located in the West Region, contact TriWest at 1-888-TRIWEST. For the South Region, contact Humana Military at 1-800-444-5445. Providers/practitioners in the North Region can visit Health Net’s website and follow the steps from there. They can choose to join the network through MHN or be a participating non-network provider. MHN, a Health Net affiliate company, manages the behavioral health care provider network in the North Region.
image courtesy of http://www.military.com/benefits/tricare/tricare-service-centers.html
Q: If a clinician is weighing the pros and cons of becoming a TRICARE behavioral health provider, what are some reasons why they should proceed?
A: It’s a chance for behavioral health professionals to serve our country. After nearly 12 years in Afghanistan and eight years (2003 – 2011) in Iraq, the United States military has an unprecedented behavioral health needs. There are 1.4 million active duty military personnel, and many of the soldiers and sailors who’ve fought the War on Terror cope with invisible (brain) injuries. Since 2001, more troops have committed suicide (2,676) than have been killed in Afghanistan (1,950), according to the Department of Defense. Just four percent of the Pentagon’s $53 billion annual medical budget is allocated to behavioral health, according to a recent Time magazine article. There is a national shortage of behavioral health professionals, according to the piece.
Q: What are the differences between certified, participating and network providers? Is the level of participation up to the individual or the regional contractor?
A: TRICARE-authorized civilian providers meet TRICARE licensing and certification requirements and are certified by TRICARE to provide care to TRICARE beneficiaries. Network providers have signed agreements with Health Net and/or MHN to provide care. They agree to file claims and handle other paperwork for TRICARE beneficiaries typically at a lower out-of-pocket cost for TRICARE beneficiaries. TRICARE Prime beneficiaries will generally see a network provider if one is available. Non-network providers do not have signed agreements with Health Net, but are still authorized to care for TRICARE beneficiaries typically at a higher out-of-pocket cost for TRICARE beneficiaries. Health Net has ahandbook that defines these terms.
"In 2011, the average turnaround time for Health Net to pay mistake-free claims was one week"
Q: Does TRICARE offer flexibility in terms of choosing to accept patient assignments on a case by case basis?
A: Yes. Network providers must accept assignment of a patient’s TRICARE benefits, while non-network providers can choose to accept assignment on a case-by-case basis. When providers elect not to accept assignment, Health Net will process the claim and pay the beneficiary. The provider will then collect their portion, which may not exceed 115 percent of the TRICARE maximum allowable amount.
Q: A common belief in the field is that the TRICARE reimbursement rate is low. Can you speak to this?
A: TRICARE reimbursement is similar Medicare’s. For some services, it is identical to that of Medicare. For others, it might be slightly more or less. With that in mind, it’s important for providers to know that the population of TRICARE beneficiaries is significantly younger than the average Medicare member. As a whole, TRICARE patients consume less time and resources than the average Medicare member, making it a comparatively profitable one for the provider.
Q: Another belief is that reimbursement is slow. How do providers submit claims, and typically how long does the reimbursement process take?
A: TRICARE patients’ claims actually get paid faster than their counterparts from commercial or individual plans. In 2011, the average turnaround time for Health Net to pay mistake-free claims was one week.
Network providers are required to submit claims electronically. For providers who submit a low volume (e.g., a dozen TRICARE claims per-month) of claims, they can submit them electronically on www.mytricare.com. High-volume providers can go through one of several clearing houses.
Q: What resources or supports are available to TRICARE behavioral health providers? Any continuing education and training opportunities? Are there any support services (e.g., crisis hotlines, case management assistance, online support, consultation) to augment care?
A: This year, Health Net partnered with the American Red Cross and Penn State’s College of Medicine to schedule a series of symposiums to educate primary care and behavioral health professionals in the North Region. Attendees receive continuing education credits, in addition to valuable information to help them treat our military service members as they adjust to life back home. Health Net has also teamed with the CDP to promote online courses to educate professionals to assist service members and their families.
Providers are encouraged to learn more about TRICARE through Health Net’s and TRICARE Management Activity’s websites. Providerwebinars are available on Health Net’s website that feature various topics include TRICARE 101. TRICARE Management Activity offers an online TRICARE University with various online courses and information about the program.