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DO MEDAL OF HONOR RECIPIENTS GET HEALTH INSURANCE MANUALS
DO MEDAL OF HONOR RECIPIENTS GET HEALTH INSURANCE MANUAL
DO MEDAL OF HONOR RECIPIENTS GET HEALTH INSURANCE CODE

Medical Necessity Guidelinesįor coverage criteria applicable to USFHP, refer to the Commercial medical necessity guidelines available in the Resource Center.

DO MEDAL OF HONOR RECIPIENTS GET HEALTH INSURANCE MANUAL

Note: Providers are reminded to check the member’s ID card to identify USFHP members.įor additional information, refer to the Billing section of the USFHP Provider Manual or call Provider Services at 800.818.8589. This includes federal and state employee insurances. Providers must first reimburse Medicare for any previous payment made in error, and must then bill USFHP for compensation of those services.Īny private health insurance, with the exception of Medicare Supplement plans, should be billed prior to billing USFHP. USFHP cannot compensate for claims that have been billed to and compensated by Medicare. For a list of services covered by USFHP, refer to the TRICARE Guidelines. For such instances, Medicare should be billed first, followed by USFHP. Medicare may be billed only for services not covered by USFHP, e.g., end-stage renal disease. When billing services for USFHP members, providers are reminded not to bill Medicare for services covered by USFHP. If submitting on paper, send appeals to the following address:Īttn: Filing Limit Appeals Billing Information Appeals can be submitted via the secure Provider portal or mail and must be received within 90 days from the date of denial.

DO MEDAL OF HONOR RECIPIENTS GET HEALTH INSURANCE CODE

For updated information about codes that may or may not be covered under USFHP, refer to TRICARE’s No Government Pay Procedure Code List.Ĭlaims not received within the 90-day filing limit will be denied with the option to appeal. Note that coverage may differ from Medicare. Rates for services for USFHP members are determined by TRICARE and are updated annually. Providers that feel a member with complex medical needs would benefit from working with a nurse care manager can make a referral by calling 888.766.9818, ext. Members are supported by the Tufts Health Plan Clinical Support programs. This affiliation provides members with access to a select network of providers and hospitals, as well as to specialty and ancillary providers. Tufts Health Plan is contracted with USFHP as a third-party administrator to process claims, referrals and authorizations, as well as offer care management and member service support. For more information on coverage and eligibility, refer to the USFHP website. USFHP meets the requirements for minimum essential coverage under the Affordable Care Act.

Medal of Honor recipients and their families.

Former spouses and survivors and of deceased service members.

Family members registered in the Defense Enrollment Eligibility Reporting System (DEERS).

TRICARE provides comprehensive coverage for uniformed service members and their families around the world, including: ( Note: Providers should reference the 2015 editions)įor additional information regarding policies and procedures, including claims submission and appeals, refer to the USFHP Provider Manual.

DO MEDAL OF HONOR RECIPIENTS GET HEALTH INSURANCE MANUALS

For information on TRICARE’s reimbursement policies and regulations, refer to the TRICARE Manuals Online. Providers rendering services to USFHP members are subject to TRICARE reimbursement policies and regulations. Uniformed Services Family Health Plan (USFHP) is a Department of Defense-sponsored health plan through TRICARE, serving eligible military families, for which Tufts Health Plan provides administrative services.