Removing TRICARE Barriers for Military Families

We like to say CASP is your voice in Washington. We’ve heard you loud and clear on barriers with TRICARE. And we’re bringing your concerns directly to the source.

Thousands of military families rely on TRICARE for their health benefits. Those with autistic children can access applied behavior analysis (ABA) through TRICARE’s Autism Care Demonstration (ACD) program. However, recent TRICARE changes have left families and autism service providers scrambling.

Every few years, TRICARE accepts bids from healthcare companies to administer its benefits for military families. In January, TRICARE’s new contracts took effect. Benefits are now administered by Humana Military (East) and TriWest (West).

The transition has been fraught with challenges. Right now, we’ll focus on what’s happening in the east.

Humana Military had big challenges out of the gate. It partnered with a company called PGBA to manage claims. PGBA had worked with TRICARE before. That was great, in theory.

Unfortunately, when autism service providers’ information (e.g., address, tax ID) was migrated to PGBA, the company’s database didn’t update records for providers it worked with previously.

The result? PGBA had incorrect info for hundreds of ABA organizations and individual providers, creating discrepancies between its database and the orgs’ electronic payment agreements—preventing claims from being paid. Many orgs submitted multiple EFT/ERA agreements to no avail.

At the same time, many providers experienced barriers related to outcome measures that TRICARE requires: SRS-2, Vineland-3, PDDBI, SIPA, and PSI-4 short form. Several states don’t allow BCBAs to administer these measures.

To address that in the past, TRICARE administrators contracted with Rethink BH. Regrettably, Humana Military ended that contract without communicating an alternative to providers.

Add all that up and providers were in a bad spot. They might have to exit the network if these problems weren’t fixed, endangering military families’ access to care.

CASP took action, organizing a Voter Voice campaign to raise your concerns to Congress. Immediately afterward, Humana Military contacted us.

We shared your concerns, including lack of communication, with senior leadership. Within a week, Humana Military contacted providers to explain the problem and provide a roadmap to solutions.

While it’s working on a permanent fix to PGBA’s data challenges, Humana Military is also:

• Issuing one-time advanced payments via paper check.
• Updating provider records one by one.
• Exploring third-party solutions to the challenge of outcome measures.

We’re grateful to Humana Military for working to address these barriers. We know many providers are still waiting to get paid. CASP remains in active communication with Humana Military and Congressional delegations, helping as best we can to resolve ongoing barriers.

In the meantime, if you want to share any information about TRICARE barriers, please contact Mariel Fernandez, our vice president of government affairs.

CASP will never stop working to protect access to care and advance our members’ interests.