AAH pushes for more timely payments from Tricare 

WASHINGTON – Industry stakeholders met with the Defense Health Agency recently to discuss ongoing issues with timely payment of Tricare East claims and the changes Humana Military is making to improve the process. 

The primary issue, says Laura Williard, vice president of payer relations for AAHomecare, stems from the inability to attach supporting documentation to claims submitted to Humana Military, the contractor for Tricare East. 

“We felt from a DME claims process, they weren’t meeting guidelines in the contractor’s manual based on what we were looking at,” she said. “We wanted to reach out to the DHA to get them involved in getting that fixed, so the claims will be paid in a timely fashion.” 

For its part, Humana Military has made some temporary changes in the process until it can evaluate and implement longer-term fixes, says Williard. 

Those changes, she says, include a dashboard released in December that allows providers to track claims processing, including how many claims were sent, how many were paid and what was the average length of time for payment. 

 “We’ll be able to really look at the payment process from beginning to end – we are excited about that,” she said. 

AAHomecare also raised concerns about Humana Military denying products that require a certificate of medical necessity due to lack of documentation, an issue that initially cropped up for breast pumps. Humana Military is reeducating its claims staff on the medical policy surrounding breast pump documentation and shipping requirements.   

“Their system currently looks for a CMN before looking for authorization, which is creating incorrect denials,” Williard said.  “They are working on a system fix to look for authorizations first. They're also making a change in items that require authorization.”