BU323PRW01084 A P UBLIC ATION FOR TRIC A RE P ROVIDERS ISSUE 3: 2008 T RICARE and TriWest Healthcare Alliance Corp. are pleased to announce the new Behavioral Health Care Provider Locator and Appointment Assistance Line to help eligible active duty service members (ADSMs) and active duty family members (ADFMs) find behavioral health care providers and schedule outpatient appointments. For eligible beneficiaries seeking assistance in the TRICARE West Region, TriWest manages the dedicated toll-free number at 1-866-651-4970, which is available from 8 a.m.
to 6 p.m. Pacific Time, Monday through Friday. Note: This appointment assistance line is not a crisis intervention line.
TRICARE beneficiaries seeking emergency behavioral health care assistance should call 911, call TriWest 9s Crisis Line at 1-866-284-3743 or proceed to the nearest emergency room for treatment. TriWest 9s Crisis Line is for West Region beneficiaries only and is not available to other TRICARE regions. The primary goal of this new service is to assist beneficiaries in making timely appointments for routine and urgent behavioral health care.
Keep in mind that TRICARE Prime primary care access standards concerning wait times also apply to behavioral health care appointments. Initial appointments for behavioral health care are not considered specialty care appointments. The wait ... more. less.
time for an initial urgent behavioral health care appointment with a behavioral health provider shall generally not exceed 24 hours.<br><br> The wait time for an initial routine behavioral health care appointment shall not exceed one week. Following the initial appointment, the behavioral health care provider 9s medical judgment will determine the wait time for the beneficiary 9s follow-up appointments. The appointment assistance service is available to all ADSMs and ADFMs enrolled in TRICARE Prime, TRICARE Prime Remote or TRICARE Prime Remote for Active Duty Family Members, as well as ADFMs enrolled in TRICARE Overseas Program Prime who have temporarily returned to the United States.<br><br> ADSMs do not need a referral if they seek care in the military treatment facility (MTF) and all ADSMs are encouraged to get care with military providers. However, if space is not available to meet the access standards, network referrals may be considered and a referral is required from the MTF to seek care from a civilian network provider. The referral may come from the primary care provider or from a behavioral health provider.<br><br> ADSMs with a referral may contact the appointment assistance line to schedule an appointment with a network provider. ADFMs do not need a referral for behavioral health care. They can self-refer for care.<br><br> They may call the appointment line at any time to receive assistance in making an appointment. After the first eight outpatient visits in a fiscal year (Oct. 1 3Sept.<br><br> 30), TRICARE prior authorization is required to extend the care, but a referral is not necessary. TRICARE Behavioral Health Assistance Line Helps Beneficiaries Find Providers A recent change in TRICARE policy now allows you to offer your TRICARE patients fighting morbid obesity the option of laparoscopic adjustable gastric banding (Lap-Band surgery). Patients 100 pounds or more over their ideal body weight with certain associated severe medical conditions, as well as those who weigh 200 percent or more of their ideal body weight, may be eligible for the procedure.<br><br> This policy change is retroactive to Feb. 1, 2007. For more information on surgery for morbid obesity, go to Chapter 4, Section 13.2 of the TRICARE Policy Manual , which can be found at http://manuals.tricare.osd.mil.<br><br> TRICARE Now Covers Lap-Band ® Surgery Issue 3: 2008 2 In-Hospital Newborn Care " Circumcision 4If performed after the child has been discharged from the hospital, the service is cost-shared as an outpatient service (unless it qualifies for the special cost-sharing for ambulatory surgery and the procedure is done at a hospital or free-standing ambulatory surgery center). " Screenings 4TRICARE covers AAP-recommended newborn screenings, including, but not limited to, testing for: " Hypothyroidism " Phenylketonuria " Hemoglobinopathies (for those in high-risk ethnic groups) " Galactosemia The Department of Defense closely monitors AAP recommendations in regards to newborn metabolic screening. The AAP has endorsed a report recommending expanded metabolic screening for newborns.<br><br> Additional information about the report can be found at http://mchb.hrsa.gov/screening/summary.htm and http://genes-r-us.uthscsa.edu. Well-Child Office Visits You may provide preventive care well-child visits as frequently as the AAP recommends, but no more than nine visits in two years. Visits for diagnosis or treatment of an illness or injury are covered separately under outpatient care.<br><br> The chart at right shows TRICARE-covered tests and their AAP-recommended frequency. Immunizations TRICARE covers age-appropriate doses of vaccines recommended by the CDC 9s Advisory Committee on Immunization Practices. For a current schedule, refer to www.cdc.gov/vaccines.<br><br> Other clinical preventive examinations or comprehensive health promotion and disease prevention exams are available for ages 24 months and older under the clinical preventive services benefit. Dental Care The AAP, American Dental Association ® and American Academy of Pediatric Dentistry recommend referring a child for an oral health examination by a dentist when the first tooth erupts or by 12 months of age. Early dental visits provide an opportunity to implement preventive dental health habits that meet each child 9s unique needs and keep the child free from dental and oral disease.<br><br> TRICARE offers two dental programs: the TRICARE Dental Program (TDP) and the TRICARE Retiree Dental Program (TRDP). For more information on these programs, visit www.TRICAREdentalprogram.com and www.trdp.org. For more information on TRICARE 9s well-child coverage, refer to the TRICARE Web site at www.tricare.mil or call TriWest at 1-888-TRIWEST (1-888-874-9378).<br><br> Test Frequency History/physical examination/ mental health assessment Each well-child visit Height and weight Each well-child visit Head circumference Each well-child visit through age 2 Vision screening (by a primary care manager) At birth and at well-child visit at age 6 months Comprehensive eye exam (by optometrist or ophthalmologist) Available from birth to age 6; includes eye and vision screening by a primary care manager during a routine exam at birth and at approximately 6 months of age Dental screening Each well-child visit Tuberculin test Once at age 1; once at age 2 Hemoglobin or hematocrit testing Once during first year; once during second year Urinalysis Once during first year; once during second year Blood pressure screening Annually between ages 3 and 6 T he preventive care and check-ups you provide to a child from birth to age 6 can influence that child 9s health for the rest of his or her life. TRICARE covers well-child care in accordance with American Academy of Pediatrics (AAP) and Centers for Disease Control and Prevention (CDC) guidelines. Well-child care is covered by TRICARE as clinical preventive care.<br><br> The following is a benefits overview. TRICARE Well-Child Coverage Overview 3 Issue 3: 2008 A satisfied TRICARE beneficiary is the primary goal of everyone working in the Military Health System (MHS). A key part of achieving that goal is keeping beneficiaries well- informed about the TRICARE benefit.<br><br> Following President Bush 9s August 2006 executive order to promote transparency in federal health care programs (see www.whitehouse.gov/ news/releases/2006/08/20060822- 2.html for the complete text), TRICARE is moving forward to fulfill the president 9s directive. The MHS 9s transparency initiative is designed to improve the TRICARE experience for beneficiaries and providers, and focuses on four aspects of health care delivery: " Pricing " Quality " Information technology " High quality and efficiency Pricing TRICARE openly shares its pricing information at www.tricare.mil/allowablecharges. This easy-to-use tool allows anyone to look up the TRICARE-allowable charge for the most frequently used services and procedures by region.<br><br> Quality Health care organization quality reports are available for review at www.qualitycheck.org, part of the Joint Commission 9s Web site. TRICARE beneficiaries are directed to this site for a comparison of their provider options. Note: Reports are only available for certain provider types.<br><br> Visit www.qualitycheck.org for more information. Information Technology TRICARE is leading the nation in the adoption of health information technology systems. The military 9s electronic health record, AHLTA, and the Pharmacy Data Transaction Service are just two examples.<br><br> These systems are designed to improve record-keeping and facilitate information exchange. High Quality and Efficiency With ever-evolving health care options and special programs, TRICARE strives to improve the quality and efficiency of care for our 9.2 million beneficiaries. With your help, we can work together to continually improve the patient experience and provide value and service to TRICARE beneficiaries.<br><br> A Clearer View of Health Care T riWest is now offering the spring 2008 series of TRICARE provider educational seminars throughout the 21-state West Region. Scheduled from mid-March through mid-June, these seminars furnish providers and their staffs with the latest information on TRICARE programs, policies and procedures. Even if you have previously attended a TRICARE seminar, attending a spring seminar will be beneficial.<br><br> New TRICARE information and additional reference tools will be provided. Seminars are scheduled for both medical/surgical and behavioral health providers. Providers can register online and will receive these additional benefits: " E-mail confirmation of your registration " Reminder notice prior to the scheduled seminar " Eligibility to participate in a drawing for a small prize Go to www.triwest.com to find the dates, times and locations of seminars nearest to you.<br><br> New TRICARE Provider Seminars Now Underway W e have updated the IVR tip sheet for your convenience. Now, you can use either voice or touch-tone responses to navigate the IVR system. Call TriWest Healthcare Alliance Customer Service at 1-888-TRIWEST (1-888-874-9378) to begin using it today!<br><br> Interactive Voice Response (IVR) System Tip Sheet New 4 Issue 3: 2008 TriWest Healthcare Alliance Corp. P.O. Box 42049 Phoenix, AZ 85080 CONTACTS TriWest Customer Service 1-888-TRIWEST www.triwest.com TRICARE Alaska Office 1-907-743-1800 Wisconsin Physicians Service (Electronic claims set up) 1-800-782-2680 www.wpsic.com Express Scripts, Inc.<br><br> (ESI) (Pharmacy inquiries) 1-866-DoD-TRRX 1-866-DoD-TMOP www.express-scripts.com/TRICARE TRICARE Provider News is published by the TRICARE Management Activity. Please provide feedback at www.tricare.mil/evaluations/feedback. T he human papillomavirus (HPV) test (CPT ® procedure codes 87620 387622*) is covered by TRICARE only when performed after an abnormal Pap smear.<br><br> It is to be used strictly for the assessment of women with atypical squamous cells of undetermined significance (ASCUS) or low-grade squamous intraepithelial (LSIL) cells. The HPV test is not covered when performed as a screening test simultaneously with a regular Pap smear. If you indicate on your claim that the HPV test was included in the screening as cstandard practice, d the claim will be denied.<br><br> Furthermore, you must send the test to a network laboratory for the claim to be paid by TRICARE. For further information, refer to the TRICARE Policy Manual , Chapter 6, Section 1.1 at http://manuals.tricare.osd.mil, visit www.triwest.com or call 1-888-TRIWEST (1-888-874-9378). * CPT codes are copyright 2007 American Medical Association.<br><br> All rights reserved. CPT is a registered trademark of the American Medical Association. HPV Test Covered Only with Abnormal Pap Smear<br><br>