Following TRICARE Prime guidelines, Prime enrollees must be assigned to providers in the TRICARE network. In May 2018, Health Net Federal Services, LLC (HNFS) began reassigning primary care managers (PCMs) to beneficiaries whose UnitedHealthcare Military & Veterans (UnitedHealthcare) PCMs had not yet joined the HNFS West Region network. In early June 2018, HNFS began efforts to re-enroll beneficiaries to their previous UnitedHealthcare PCMs who recently joined the HNFS network.
- In July 2018, beneficiaries whose UnitedHealthcare PCMs now show in our systems as a network PCM will be automatically re-enrolled to their previous PCM. (The exception to this is beneficiaries who have updated their PCM since receiving a reassignment notice from HNFS.) HNFS will notify impacted beneficiaries and providers.
- In August 2018, should a UnitedHealthcare PCM join the HNFS network, HNFS will look at claims history and other indicators prior to automatically transferring patient panels.
- At any time, beneficiaries can individually request a PCM change back to their UnitedHealthcare PCM who joined our network through an online request, by mailing or faxing an application, or by calling HNFS.
Frequently Asked Questions
Q: Why did HNFS change my PCM?
A: TRICARE Prime enrollees are required to seek all primary care from PCMs who are TRICARE-authorized providers in the TRICARE network. Following TRICARE Prime guidelines, HNFS is ensuring Prime enrollees are appropriately assigned to providers in the TRICARE network.
Q: Why isn’t my PCM in the HNFS network when he/she was in UnitedHealthcare’s network?
A: Providers in UnitedHealthcare’s West Region network did not automatically transfer to HNFS’ West Region network. HNFS is required to conduct a credentials review on each network provider to determine if the provider meets the minimum requirements of the Defense Health Agency, HNFS and URAC. HNFS reached out to UnitedHealthcare’s network providers beginning in September 2016 to encourage them to start the credentialing process with HNFS, as this process can take up to 90 days to complete.
Q: What happens if my PCM joins the HNFS network? Can I get changed back with a retroactive effective date?
A: HNFS can assign you back to your UnitedHealthcare PCM with an effective date no earlier than the start of his/her contract with HNFS (other date limitations may apply). Keep in mind back-dated enrollment could impact claims processing and should be taken into consideration with any retro-PCM change request. Beneficiaries who are part of the automatic enrollment reversal efforts in July 2018 will be assigned back to their PCM with a June 30, 2018, effective date.
Q: How will I be notified if my PCM is changed back as part of the July 2018 reassignment efforts? What will the effective date be?
A: HNFS will issue letters notifying beneficiaries of the PCM change. The effective date will be June 30, 2018, or the date the PCMs network contract was signed (if after June 30).
Q: Will my referrals from my original PCM still be valid if I'm moved to a new PCM?
A: Yes. HNFS will continue to honor these referrals.
Q: I changed my PCM because my UnitedHealthcare doctor wasn’t in the HNFS network. I now see he/she is in HNFS’ network and want to change back. Can I?
A: You may request a PCM change online, by mailing or faxing an application, or by calling HNFS. You must wait for confirmation of your new PCM assignment before seeing the provider, as you may be charged Point of Service (POS) if you go to that PCM before the change is effective.
Q: I didn’t realize my PCM had been changed again. Now I have a POS charge from the provider HNFS gave me. How can I get this fixed?
A: POS should not be charged on any claims for services received from the network PCM HNFS assigned to you. If you feel your claim processed incorrectly, you may request a claims review by submitting a request via the "Ask Us Secure Email" feature on our secure beneficiary portal or by sending a written request to TRICARE West – Claims Correspondence, PO Box 202100, Florence, SC 29502-2100.
Q: I wasn’t charged POS when I saw my UnitedHealthcare doctor before. Why am I now being charged POS?
A: As part of the TRICARE contract transition, DHA allowed TRICARE Prime beneficiaries to seek care from their UnitedHealthcare PCMs without incurring additional POS fees. This allowed HNFS additional time to contract providers and develop the TRICARE network. PCM assignments have since completed and TRICARE Prime enrollees must seek care from their assigned PCM. Referral guidelines will be enforced and POS charges will be applied as appropriate.