In Case You Missed It: May 2023 TRICARE West Region Updates

COVID-19 public health emergencies end. The President’s declared emergency period ended April 10, 2023, and the U.S. Department of Health and Human Services’ federal public health emergency period ended May 11. This means some temporary TRICARE policies put in place in response to the COVID-19 pandemic are no longer in effect.

Breast milk storage bag quantity update. Retroactive to Jan. 25, 2023, TRICARE now covers 100 breast milk bags every 30 days. This change will help with billing by aligning with how breast milk bags are packaged. Previously, only 90 breast milk storage bags were covered.

ePrescribing to military pharmacies. Did you know you can send prescriptions to military pharmacies electronically? Sending electronic prescriptions, also known as ePrescribing, allows for faster service and more accurate records. It also decreases the risk of lost written prescriptions and medication errors. Not sure if your local military pharmacy accepts electronic prescriptions? Visit www.health.mil/eRx to view the current list of military pharmacies that accept electronic prescriptions from civilian providers.

Learn more about CareAffiliate® for referral and pre-authorization requests. As a TRICARE West Region provider, you are required to submit referral and pre-authorization requests online.* The preferred method for online submissions continues to be CareAffiliate, which can be used for inpatient and outpatient requests, and allows for attachments. Want to learn more about CareAffiliate? Attend a live webinar presented by one of our TRICARE educators. View our current schedule today!
*Exceptions for providers in Alaska apply

Using our online Authorization Change Request Form. There may be times when you need to request a change to an outpatient authorization or referral already approved by Health Net Federal Services, LLC (HNFS). Keep in mind that changes can only be accepted for active referrals and authorizations if the services have not yet been rendered and are made within 30 days from the original approval date. Making changes is simple using the Authorization Change Request Form.

Autism Care Demonstration (ACD) discharge summaries. Discharge summaries are an incredibly important part of the applied behavior analysis (ABA) treatment a beneficiary receives under the ACD. Discharge summaries include essential information regarding the reasons a beneficiary’s treatment ended and can assist HNFS with determining any current or upcoming support a beneficiary may need. This is vital to continuity of care. Please take a moment to review common questions and answers surrounding discharge summary requirements.

Class I recall for certain Philips Respironics DreamStation 1 continuous positive airway pressure (CPAP) and bilevel positive airway pressure (BiPAP) machines. In February 2023, Philips Respironics (Philips) recalled some reworked Philips DreamStation 1 CPAP and BiPAP machines. This recall is for DreamStation 1 CPAP and BIPAP devices reworked by Philips that were also recalled in June 2021. For specific recall details such as product models and serial numbers, refer to the FDA’s website.

Billing guidance for Spravato® nasal spray. We recognize some providers include HCPCS code J3490 with a nominal charge ($0.01) for administrative purposes. Per TRICARE policy, HNFS may not reimburse for HCPCS code J3490 on Spravato claims, as providers are to buy-and-bill under HCPCS codes G2082 or G2083 only. HNFS will only reimburse claims submitted by providers who have administered the drug. We will not accept Spravato claims submitted by pharmacy providers. As a reminder, providers may not bill solely for Spravato (HCPCS code S0013), as payment for the drug is included in G2082 and G2083 reimbursement.

Resources for asthma management. If you have patients diagnosed with asthma, they can easily access educational information with our Basics of Asthma Management online program. One-on-one coaching with an asthma specialist is also available. To nominate a patient, visit our Disease Management FAQ section.

It’s Mental Health Awareness Month. We can help. Do you have patients dealing with stress, anxiety or depression? Refer them to our Learning Center where they can listen and view recorded classes on these topics. Visit our Provider Toolkit for patient topic sheets and additional stress management resources. We also offer one-on-one stress management coaching, and anxiety or depression coaching with a disease management specialist.

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