TRICARE Regions, Contractors Changing

July 22, 2016

If you're enrolled in TRICARE Prime in the South or West TRICARE region, you'll see some changes coming next year.  

On July 21, the Pentagon announced it is consolidating the current three TRICARE regions (North, South, and West) into two (East and West).  

The new East region will combine the old North and South regions and will cover the District of Columbia; Alabama; Arkansas; Connecticut; Delaware; Florida; Georgia; Illinois; Indiana; the Rock Island Arsenal area of Iowa; Kentucky; Louisiana; Maine; Maryland; Massachusetts; Michigan; Mississippi; the St. Louis, Missouri, area; New Hampshire; New Jersey; New York; North Carolina; Ohio; Oklahoma; Pennsylvania; Rhode Island; South Carolina; Tennessee; most of Texas; Vermont; Virginia; West Virginia; and Wisconsin.  

The new contractor for the East region will be Humana Government Business, Inc., which currently manages the South region.  

The West region will remain unchanged geographically, but the regional contractor will change next year from United Health Care to Health Net Federal Services LLC, which currently manages the North region.  

What does this mean for beneficiaries?  

Those in the current South region probably won't see much change as their contractor will remain Humana. Those enrolled in the US Family Health Plan also will see no changes.  

For those in the current North and West regions whose contractors will change, it depends on how many of the providers in the current contractors' networks will agree to transition to the new contractors'. In the past, new contractors have proven fairly successful in recruiting the old contractor's providers to continue participating. But it's possible that some number of beneficiaries will need to switch to a new doctor.  

Regardless, these changes aren't scheduled to happen until next year, and there's not even a specific date at this point.  

In the past, new contract awards have been protested by unsuccessful bidders, and many of those protests have been upheld, resulting in further delay of the new contract's start.  

Several aspects of the new contracts should be positive for beneficiaries. Going from three contractors to two will mean less disruption for relocating families, as well as improved continuity of care, and consistency of the benefit.  

According to a senior defense official, the new contracts will:  

  • make it easier to enroll;
  • improve communication between military and private sector providers to record all appointment information in the patient's electronic health record;
  • provide flexibility to adopt new innovations;
  • place more emphasis on customer satisfaction;
  • decrease wait times for specialty appointments; and
  • provide improved case management for special needs families.  

An official said the transition plan entails a “test drive” period to make sure all systems are working as expected before the changeover occurs, and beneficiaries will be kept apprised of progress all along the way.

 

 

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