April 1, 2013 to March 31, 2014 TRICARE North Region Provider Handbook Now Available Online

Friday, March 1, 2013

The April 1, 2013 to March 31, 2014 TRICARE North Region Provider Handbook, which contains the most current information concerning TRICARE contract requirements, is now available online. Please review the full contents of this updated handbook as it becomes effective April 1, 2013, and is a component of your TRICARE Provider Agreement.

We would like to remind you of several key requirements and other general information to assist you with the TRICARE program:

  • Clearly legible specialty care consultation reports, also known as CLRs (consultation reports, operative reports and/or discharge summaries), must be issued to referring providers. For patients referred from military treatment facility (MTF) providers, reports must be returned to the MTF. The CLR fax number for each MTF is maintained in the CLR Fax Matrix located on the Clearly Legible Reports page.
  • Network providers must supply Health Net with a Health Insurance Portability and Accountability Act (HIPAA) compliant fax number for referrals and prior authorizations, and an email address to ensure secure electronic communications.
  • TRICARE network providers shall not receive or accept, for any reason, reimbursement in excess of the TRICARE/CHAMPUS Maximum Allowable Charge.
  • Network groups must maintain credentialing requirements for all providers within the group.

For your convenience, our website allows you to:

  • Update your demographic information, such as location, providers in your practice, telephone, email, and fax number.
  • Register as a TRICARE provider. Online registration gives you access to enhanced tools and new features as they become available.
  • Attend TRICARE provider webinar education sessions and learn more about TRICARE.
  • Access the Prior Authorization, Referral and Benefit Tool.
  • Sign up for electronic data interchange (EDI) to submit claims.
  • Take advantage of electronic funds transfer (EFT) for efficient claims reimbursements.

We thank you for your continued support of the TRICARE program – dedicated to providing the best health care possible to active duty service members, National Guard and Reserve members, their families and retirees who have served our country.