HNFS to Humana Military: What You Need to Know

Sunday, November 12, 2017

The TRICARE North Region transition into the new TRICARE East Region, which will be managed by Humana Military, begins Jan. 1, 2018. We know you have questions about continuity of care for your TRICARE patients. Please review these frequently asked questions to assist you during the transition. See our TRICARE North Inquiries guide for more information.

Authorizations and Referrals

Tip: Starting Jan. 1, 2018, all referral and authorization inquiries, regardless of approval date, should be directed to Humana Military for the TRICARE East Region.

Q: My patient was authorized by HNFS for services that extend beyond Jan. 1, 2018. Will Humana Military honor the authorization or do I need to request a new approval from them before I can treat my patient in 2018?
A:
Humana Military will honor authorizations and referrals issued by HNFS for services that extend beyond Jan. 1, 2018, through the expiration date. 

Q: Will Humana Military honor referrals and authorizations issued to providers who will be out-of-network as of Jan. 1, 2018?
A:
Yes. Humana Military will honor the referral through the expiration date. Please contact Humana Military for any questions you may have regarding the referral or authorization.

Q: Who should I contact to fix an error on a referral requested before Jan. 1, 2018, for services on or after Jan. 1, 2018?
A:
After Dec. 31, 2017, contact Humana Military for all referral questions regardless of when the referral was processed.

Q: How can I find out if Humana Military’s referral and prior authorization requirements differ from HNFS’?
A:
While TRICARE managed care support contractors must adhere to program manuals, each is allowed some discretion as to when a prior authorization or referral may be required. Visit HumanaMilitary.com/provider-east for East Region authorization information. 

Case Management

Q: How are HNFS and Humana Military handling the transition of complex cases?
A:
HNFS has already begun coordinating the transition of complex cases directly with Humana Military to ensure continuity of care. Affected beneficiaries and providers will be notified by HNFS’ and/or Humana’s Case Management team.

Provider Contracting

Q: I’m currently a network provider with HNFS. What do I need to do to remain a network provider under Humana Military?
A:
No action is required. HNFS and Humana Military have agreed to transition provider contracts currently aligned with HNFS in the TRICARE North Region to Humana Military, effective Jan. 1, 2018. Through this agreement, current TRICARE network provider status will remain as-is when Humana Military becomes the managed care support contractor for the TRICARE East Region.

Note to behavioral health network providers: Only the TRICARE section of MHN provider agreements will transition to Humana Military. Network behavioral health providers will remain contracted under MHN for all other product lines outlined in your MHN agreement.

Q: My TRICARE credentialing is not complete or is set to expire before Jan. 1, 2018. Do I have to start over with Humana Military?
A:
Health Net Federal Services is no longer credentialing new providers for TRICARE in the North Region. If you plan to continue participation as a network provider in the new East Region on or after Jan. 1, 2018, please contact Humana Military for information on their credentialing process. If you're contracted with HNFS for other lines of business, we will continue your credentialing/re-credentialing process for those networks.

Claims

Q: If Humana Military honors an HNFS authorization and the treatment date is in 2018, where do I send the claim?
A:
In general, claims for dates of service on or after Jan. 1, 2018, should be submitted to Humana Military for processing. See our TRICARE North Inquiries guide for more information.

Q: How do I determine where to send my TRICARE claims?
A:
When submitting your TRICARE claims, the date of service will generally determine whether HNFS or Humana Military should receive the claim.

  • All claims for dates of service prior to Jan. 1, 2018, should be submitted to HNFS as long as your office submits the claim prior to April 30, 2018.
  • All claims for dates of service on or after Jan. 1, 2018 should be submitted to Humana Military.
  • Humana Military will begin processing all East Region claims, regardless of date of service, on May 1, 2018.

As a reminder, network providers must submit TRICARE claims via electronic data interchange.

Tip: With the exception of home health care claims, outpatient claims that span calendar years must be split so only 2017 or 2018 dates of service are on a claim.

Q: How do I submit claims?
A:
If your claim must be submitted to HNFS, you can continue to access claims submittal instructions on our Claims tab through March 30, 2018. You can also visit HumanaMilitary.com/provider-east for claims submission instructions on or after Jan. 1, 2018.

Q: Who do I contact if I have a question regarding a claim with a date of service on or before Dec. 31, 2017?
A:
You can contact HNFS at 1-877-TRICARE (1-877-874-2273) through March 31, 2018, for any questions regarding claims with a date of service before Jan. 1, 2018. On or after April 1, 2018, you will need to contact Humana Military at 1-800-444-5445, regardless of the date of service.

Q: I received a notice from HNFS regarding an overpayment on claims paid on or before Dec. 31, 2017. If it’s after Jan. 1, 2018, where do I send the recoupment?
A:
Recoupments for claims processed on or before Dec. 31, 2017 can be sent to HNFS before June 30, 2018.

TRICARE North Region Refunds
PO Box 870153
Surfside Beach, SC 29587-8753

Appeals

Q: How do I submit an appeal for a claim with a date of service on or before Dec. 31, 2017?
A:
Appeals for claims with dates of service before Jan. 1, 2018, can be mailed or faxed to HNFS until April 30, 2018.

Health Net Federal Services, LLC
Administrative Reviews
PO Box 2606
Virginia Beach, VA 23450-2606

Customer Service

Q: When is the last day I will be able to log in and access my www.hnfs.com account?
A:
You’ll be able to access your www.hnfs.com accounts and information through March 30, 2018. After April 1, 2018, you may access information regarding claims, referral and authorizations submitted in 2017 at myTRICARE.com until May 1, 2018.

Q: Will the HNFS customer service representatives be available to answer TRICARE North Region questions after Jan. 1, 2018?
A:
You may contact our TRICARE North Region customer service representatives at 1-877-TRICARE (874-2273) from Jan. 1–March 31, 2018, only for questions about TRICARE North Region claims with dates of service on or before Dec. 31, 2017. After Dec. 31, 2017, all other questions will need to be directed to Humana Military. On or after April 1, 2018, all inquiries must be directed to Humana Military. See our TRICARE North Inquiries guide for more information.

Q: Where can I learn more about Humana Military?
A:
Visit HumanaMilitary.com/east to review Humana Military’s provider handbook and access additional East Region resources.