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    TRICARE®
    Provider News
O C T O B E R 2 0 1 1
Contacts
Health Net Customer Service
877-TRICARE (877-874-2273)
www.hnfs.com
PGBA, LLC
Electronic claims. EFT set up
877-EDI-CLAIM (877-334-2524)
Express Scripts, Inc.
Pharmacy inquiries
877-363-1303
www.express-scripts.com/TRICARE
Visit us at www.hnfs.com
Keep Our Provider
How the Provider Relations Outreach
Directory Current—
Specialists Can Help
Update Your Information
Have you recently been contacted by one of our Provider Relations Outreach Specialists (PROS)? These specialists are dedicated to making sure our Network Provider Directory has the most up-to-date information—a benefit to both your practice and your patients. Twice a year, the PROS will reach out to network providers to verify the following demographic information: • Name of practice • Physical address • Phone/fax/email • Tax identification number • Pay to address • Any other practice locations and the providers in those locations In addition, PROS help maintain current provider credentialing It is important to provide Health Net Federal Services, LLC by alerting providers when they need to begin the (Health Net) with your practice's current demographic recredentialing process. PROS can also educate providers information. Updating provider demographics allows Health about TRICARE policies and procedures, and serve as a general Net to provide accurate information to TRICARE beneficiaries, resource for TRICARE administrative information.
offer proper care coordination and ensure claims are paid on time and correctly.
While the majority of the PROS' contact with providers is by telephone, you may receive a site visit as well.
Health Net network providers are urged to visit the Network Thank you for your cooperation in our outreach efforts. demographic information. Please continue to visit www.hnfs.com or contact 877-TRICARE (877-874-2273) for TRICARE assistance.

HIPAA 5010 Implementation –
Is your office ready?
Health Insurance Portability and Accountability Act (HIPAA)
requires covered entities and business associates to implement
and use mandated standards in the electronic transmission of
health care transactions, such as claims, remittance advices,
eligibility confirmations, and claims status requests and
responses. The Department of Health and Human Services
adopted a final rule to replace the HIPAA Accredited Standards
Committee (ASC) X12 versions 4010A1 with ASC version 5010.
Verifying Eligibility
The implementation date of this change is January 1, 2012. with New Beneficiary
The following provider- and employer-related transactions are covered under 5010 HIPAA requirements: As a reminder, Social Security numbers (SSNs) are no longer printed • 837 claims/encounters (professional, institutional and dental) on new Department of Defense (DoD) identification (ID) cards. This change was made by the DoD to protect the personal • 276/277 health care claims status request and response identity information of our beneficiaries. • 835 health care payment and remittance advice The back of the new ID card will contain the following identifiers: • 270/271 eligibility request and response • DoD ID Number – a 10-digit number that is not used for
TRICARE eligibility, referral, authorization or claims purposes.
• 278 certification and authorization request and response • DoD Benefits Number – an 11-digit number that relates to
• 834 enrollment and disenrollment in a health plan TRICARE benefit eligibility.
• 820 health plan premium payment Continue to Use Sponsor and Family Member Social
Security Numbers
Although not part of the HIPAA-mandated transaction requirements, the 277U claims acknowledgement will be Although the DoD Benefits Number is now on new ID cards upgraded to version 5010 277CA.
instead of SSNs, providers must continue to use the sponsor's
and family members' SSNs when verifying eligibility (either online
Preparing for HIPAA 5010
or through Interactive Voice Response system at 877-TRICARE) Providers who submit data directly or through clearinghouses and when submitting referrals, prior authorizations and claims.
should be ready to support the HIPAA 5010 transition by January 1, Systems are in the process of being updated to start accepting 2012. Providers should contact their practice management system the 11-digit DoD Benefits Number and we will keep you informed vendors or clearinghouses to make sure their systems will be able to through our website when that occurs. In the meantime, please support the new HIP continue to use the sponsor's and family members' SSNs.
TRICARE Webinars—Live and Recorded Sessions
Health Net continues to offer live TRICARE webinars twice a month. If you are unable to attend a live TRICARE webinar, try viewing
one of our self-paced, recorded sessions. For a complete list of webinars and registration information, visit our Online Provider

Health Net's New Mailing Addresses
Many of Health Net's mailing addresses have changed, including those for appeals, grievances and administrative reviews. For a

Express Scripts and TRICARE
Patient Safety Corner
Now Offer e-Prescriptions
Teaching Patients How to Safely Take Anticoagulants
Providers may now e-prescribe for TRICARE beneficiaries by Health care providers play an important role in teaching their submitting prescriptions to Express Scripts using the Surescripts patients how to safely take anticoagulants. Educating patients e-prescribing network. The process is simple and beneficial for and their family members about how to take anticoagulants your practice and your TRICARE patients. properly and preparing them for what to expect can help prevent How does e-prescribing work?
readmissions and future complications. The following are some key points to discuss with your patients: Providers may get the beneficiary's information from their • Explain the need for anticoagulant therapy. Certain medical
practice management system or enter the beneficiary's conditions (e.g., atrial fibrillation, heart attack, stroke) put information directly into their e-prescribing application. By patients at higher risk for blood clots. They should know selecting TRICARE in the formulary section, providers can view why they are taking this drug and understand how it works. medications covered by the TRICARE pharmacy benefit. (The • Take the drug as directed. It is important patients follow the
TRICARE formulary will appear in the available formulary listing instructions (i.e., avoid skipping a dose or taking more than accessible with most e-prescribe systems.) directed). Tell them what they should do if they miss a dose. The preferred pharmacy for TRICARE beneficiaries is Express • Duration of therapy. Patients should be instructed how long
Scripts Mail Pharmacy. This location also can be selected from they will be on anticoagulant therapy. They may also need a the list of mail order pharmacies. If the beneficiary does not want temporary lower dose or to discontinue use before surgery to use pharmacy home delivery, providers may use listed network or a procedure.
retail pharmacies.
• Potential drug and herbal interactions. Certain drugs and
Note: Currently pharmacies at the military treatment facilities
herbal medicines can raise or lower the international (MTFs) do not accept e-prescriptions. If a beneficiary prefers normalized ratio (INR) response. Patients should alert all to have his or her prescriptions filled at an MTF, he or she may their other health care providers about their anticoagulant therapy as it may interfere with other drugs and treatments continue to ask for a written prescription.
that have been prescribed.
What are the benefits of e-prescribing?
• Dietary interactions. Warfarin (COUMADIN) is considered
a vitamin K antagonist. Patients should be aware of foods • Safe—eliminates errors due to misread handwriting that are high in vitamin K. Patients may also benefit from speaking to a registered dietician. They should learn how • Paperless—cuts down on the cost of paper, faxing and to balance their diets to avoid consuming high amounts of administrative time, benefitting you and the environment vitamin K in a single episode, which can change their INR. • Signs and symptoms of adverse effects, especially bleeding.
• TRICARE formulary adherence—saves beneficiaries money Patients should be aware of signs and symptoms of by allowing providers access to medications covered in the potential bleeding and when to seek immediate medical TRICARE formulary care. These may include dizziness or weakness, a cut that does not stop bleeding, red or brown urine, red or tarry • Electronically enabled prescriptions—transfers prescriptions stools, brown or bright red vomit, severe headache or over a secure network, assuring origin authentication abdominal pain, and unusual bruising. • Generic reminder (when available)—saves even more money • Follow-up and careful monitoring. It is important to assess
for beneficiaries the patient's ability to return for follow-up care. Some patients may find traveling for laboratory follow-up or Additional information and assistance can be found through office visits to be time consuming, expensive or difficult to your local Regional Extension Centers at schedule. They should know frequent INR blood testing is necessary to determine a safe range and optimal dosage for their anticoagulant therapy. Patients may need reminders for routine lab tests.
Healthy People 2020 Corner
• Strategies to minimize potential for bleeding and prevent
injury. This may include suggesting they use a soft toothbrush,
Healthy People objectives support the continued improvement an electric shaver and waxed dental floss, and wear shoes in of screening rates for breast cancer. Visit www.healthypeople.
the house and protective gear with physical activities. gov to learn more about these national objectives and to find We encourage providers to look for teaching opportunities in clinical tools and resources to support your practice.
practices and be a part of the patient safety solution.
Agency for Healthcare Research and Quality (2010). Blood thinner pills: Your guide to using them safely. Retrieved from, http://www.ahrq.gov/consumer/btpills.htm

Health Net Federal Services, LLCP.O. Box 2890Rancho Cordova, CA 95741 Discuss Mammography Now TRICARE Benefits
The chance a woman will be diagnosed with breast cancer over her For TRICARE beneficiaries, one screening mammogram
lifetime is one in eight.1 This risk, however, is not evenly distributed every 12 months is covered for women with no symptoms among all women. Risk can vary by a woman's level of breast beginning at age 40. Women with a high-risk* of breast cancer density, family history of breast cancer among first-degree relatives may receive screening mammograms beginning at age 35. and personal history of breast biopsy, among other factors.
In addition, mammograms for a woman with certain clinical symptoms are not limited to annual screenings. While the advantages, and disadvantages of mammography—particularly false-positive results, must be balanced, it is essential all women are informed about breast cancer screening and understand regular mammography screening is one of the most effective ways to detect breast cancer early. Health Net offers toolkits, flyers and handouts that can help you accomplish this. These resources, which you can print and display around your office, are available on the provider Wunder the Resources tab. Working together we can help make a difference. *High-risk indicators include women with a personal history of breast cancer; a personal history of biopsy-proven benign breast disease; a mother, sister or daughter who has had breast cancer; and a woman who has not given birth prior to age 30. 1 National Cancer Institute. (17 September 2010). "Probability of Breast Cancer in American Women." Retrieved from http://www.cancer.gov/cancertopics/factsheet/ Stay Healthy with Health Net

Source: https://www.hnfs.net/content/dam/hnfs/tn/prov/news/pdf/Oct_2011_TRICARE_Prov_News_web.pdf