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🧑⚕️ Who: Healthcare providers, military service members, dependents, retirees, Humana Military
•📜 What: TRICARE’s claims processing transition caused widespread payment delays
•📆 When: Change took effect on January 1, 2025, with issues continuing for over a month
•📍 Where: TRICARE East Region, affecting military and civilian healthcare providers
•❓ Why: This disruption means that healthcare providers might start to charge you out of pocket until this issue is resolved.
If you or someone you love is in the military – you probably already know about this. Well maybe not, but you should because it will affect your wallet for an unknown amount of time.
Several news outlets have already discussed the fact that Tricare claims processing companies have screwed up big during a changeover in billing managers – and it might cost you money if you are a healthcare provider or if you are someone who depends on Tricare to get medical help.
Here’s what happened: TRICARE, the socialized medicine of the military (sorry, it’s true) that allows service members, their dependents, and retired military members to get free* healthcare, changed billing providers starting on Jan 1.
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But, the changeover didn’t go well. The new company in charge of managing payments to non-military healthcare providers on behalf of TRICARE lost the records and certifications of an unknown number of providers – from nurse practitioners and physician assistants to Licensed Mental Health Counselors.
Humana said in a statement “Before Humana Military was awarded the TRICARE East Region contract for T-5, the company issued a Request for Proposal to prospective suppliers to submit papers to perform claims processing in the new contract. Humana Military evaluated the papers received and awarded the work to a new claims processing provider based on technical capabilities, past performance and price.” They added that “. Humana Military has identified the root cause of this issue and is working to resolve it and prevent it from recurring. This incorrect data has inhibited Humana Military’s claims administration system from processing claims submitted by impacted providers. Humana Military has made significant progress in correcting and updating impacted providers’ records on an ongoing basis since this issue was identified earlier this month. At this time, we anticipate all impacted providers’ records will be corrected as soon as possible.”
That means those providers haven’t been paid what they’re owed – many of them since the beginning of the year. And they have bill of their own they need to cover – which are now backing up, too.
The crisis for the providers turns into one for military members, dependents, and retirees when the providers have to require cash payment instead of taking TRICARE insurance – meaning the free* healthcare you got as a benefit when you signed on the dotted line – isn’t so free anymore.
Humana Military’s website acknowledges the issue with a couple of banners on the top of their website that are chock full of stock images of healthcare providers looking very seriously at what I can only assume are their delayed payment claims. “We understand that you may be experiencing challenges with claim submissions,” a message reads, “We acknowledge that our usual processing times have been delayed due to a major system transition.”
Don’t worry, though, “We are actively working to expedite resolutions and anticipate returning to our standard turnaround times within the next several weeks,” the banner adds.
Robert Mayor of Mayor Mental Health is one of the healthcare providers who’s survived in the payment lurch for the last five weeks. Obviously, he’s not thrilled about not getting paid for more than a month. While he hasn’t seen a dime for the work he’s provided in the last month, he’s most furious about how avoidable he believes all of this was. “TRICARE knew this merge was going to happen. This wasn’t like an abrupt contract switch. They had months, if not years to prepare for January 1, 2025,” Mayor said with exasperation in his voice over the phone when we talked.
Claims managers Mayor worked with say they have elevated his case and plan to send him what they call an “advance payment” check to help cover costs Humana, TRICARE and the claim processor work out their issues.
Sure, he adds, this situation will get resolved eventually – but the military members et al that rely on Tricare could find it even more difficult to get the care they need after this – and more and more providers throw up their hands and simply refuse to take TRICARE at all after this. After all, Mayor says, they are already the HMO that pays providers bargain basement prices for their services. “they already pay us low enough that to not pay us at all is just another slap to the face,” Mayor added.
