Access to Tricare enrollment and online beneficiary changes will be frozen for days over the coming week as the system transitions to a new contractor -- potentially causing disruptions for those trying to make changes to their health care plans and personal information.
A three-day enrollment freeze starting Friday will allow the Defense Health Agency and contractors to conduct software upgrades, perform maintenance and begin the transfer of beneficiary enrollment information. DHA spokeswoman Brenda Campbell said enrollment freezes are common -- and required -- in contract transitions, allowing for the capture of all DEERS records data to establish a baseline for the new contractors.
A Defense Health Agency official told Military.com on Tuesday that the planned outages and restrictions are the result of "lessons learned" from the bungled 2017 contract transition and will require just four days of an enrollment freeze rather than the three weeks it took during the last transition, which resulted in thousands of beneficiaries being dropped.
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For up to four days starting Oct. 25, all Tricare beneficiaries and prospective patients in the U.S. and overseas will be unable to enroll in the Defense Enrollment Eligibility Reporting System, or DEERS, as well as the Tricare health program. Nor will they be able to change their plans or update their information in the systems, DHA officials announced Monday.
From Oct. 28 through Dec. 31, beneficiaries who reside in the U.S. will have to call their regional contractor to make any changes to their plans rather than use the online resource milConnect as they may be used to doing.
Personnel and family members currently living overseas may use milConnect, but those who transfer from the U.S. to an overseas location between the end of October and New Year's Eve must call the Tricare international contract provider, International SOS, to enroll in Tricare at their new location.
The outages and limitations are part of the planned transition to Tricare's new regional contracts, which will begin Jan. 1. Starting New Year's Day, Humana Military will continue managing the Tricare East Region, but TriWest Healthcare Alliance will take over the West Region and add Arkansas, Illinois, Louisiana, Oklahoma, Texas and Wisconsin to its area of responsibility.
The 2017 Tricare contract transition was plagued by patient enrollment and referral problems, payment delays, incorrect reimbursements to providers, and the loss of payment information for 224,000 beneficiaries that resulted in at least 15,000 beneficiaries being dropped by Tricare.
The Government Accountability Office found that the Defense Health Agency failed to adequately oversee and manage that transition.
This year, the DHA hopes to avoid any transition problems. Officials said that any DEERS transactions attempted during the blackout periods will be held in a "pending" status for later updating in the DEERS database.
"There should be no noticeable delays in referrals, authorizations or other transactions," the official said in an email.
The official also said that the contractors hope to avoid any issues with patients dropped as a result of a lack of payment information because the transfer of that data was begun two months earlier than in 2017.
According to the DHA, the contractors have made contact with patients and will continue to press beneficiaries who pay fees or premiums by debit or credit card or electronic fund transfer to provide authorization to TriWest.
"DHA, along with TriWest, are implementing a robust outreach campaign to encourage beneficiaries to complete this action early," the official said.
Beneficiaries who use military allotments will have their accounts transferred automatically.
The DHA encourages all beneficiaries to check their information in DEERS before the enrollment freeze on Oct. 25. Beginning Oct. 28 through Dec. 31, if they want to make changes to their plans such as changing their primary care manager if they are in Tricare Prime; changing their plan as the result of a qualifying life event; or switching plans under Tricare Open Season, which runs this year from Nov. 11 to Dec. 10, they should call Humana Military at 800-444-5445 if they live in the East Region or Health Net Federal Services at 844-866-9378 if they live in the current West Region.
TriWest is expected to publish its provider directory in the coming weeks and will open its call center, at 888-874-9378, on Nov. 11.
Tricare also is expected to publish its rates for programs, including enrollment fees, cost shares and pharmacy copays in the next few weeks.
New beneficiaries will be able to enroll in a Tricare health plan from Oct. 28 to Dec. 31 by going to milConnect, clicking on "I want to" and selecting "Manage Health Benefits," according to the DHA.
These restrictions do not apply to patients who wish to make changes to their Federal Employee Dental and Vision Insurance Program. They still will be allowed to do so during open season, which also runs from Nov. 11 to Dec. 9.
The three-day DEERS enrollment blackout will affect beneficiaries who use Tricare For Life, a program that serves as a secondary payer for Medicare, but they will not be affected by the transition of Tricare management companies.
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