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 remove patients from PCM rosters?
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 am I not a PCM in the HNFS network when I was one 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: I completed the HNFS credentialing process but still am not listed in the network directory. Why?
A: HNFS experienced a delay in moving provider data from its provider data repository to the network directory due to a change in requirements of provider elements needed (such as Social Security number). This resulted in a workaround to what would normally be an automated process. HNFS is working daily to ensure providers get loaded properly and timely. We encourage beneficiaries and providers to check the directory often, as updates are made daily.
Q: If I join the HNFS network, will my patients be reassigned back to me?
A: Beneficiaries who are part of HNFS’ automatic enrollment reversal efforts in July 2018 will be assigned back to their PCM with a June 30, 2018, effective date (or the date the provider contract was signed, if after June 30). Beneficiaries will receive PCM change letters once the reassignment is complete. The original UnitedHealthcare PCMs will be contacted by HNFS via provider relations representative outreach notifying them of the patient panel move. Outside of the automatic enrollment reversal efforts in July 2018, beneficiaries can request a PCM change back to you with an effective date no earlier than the start of your 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.
Q: Will my TRICARE Prime patients be charged Point of Service (POS) if they continue to see me?
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. As of July 1, 2018, PCM assignments have 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.
Keep in mind, if a beneficiary sees a network PCM provider type who is not his/her assigned PCM, the claim will process the same as if the beneficiary went to urgent care (POS will not apply).
Q: Will referrals issued still be valid if my patient is moved to a new PCM?
A: Yes. HNFS will continue to honor these referrals.
Q: How will claims pay if beneficiary sees a non-network provider that is part of a network group?
A: If billed under the network group, the claims will pay as network.