|
1/25/2025 0 Comments Understanding the TriWest Healthcare Alliance Transition and NDAA Section 714: A Comprehensive Guide for Mental Health Providers Serving Military CommunitiesThe military healthcare landscape is undergoing significant changes with two major developments: the transition of TRICARE West services from Health Net Federal Services (HNFS) to TriWest Healthcare Alliance, and the implementation of Section 714 of the Fiscal Year 2025 National Defense Authorization Act (NDAA). This article analyzes these changes, potential implications for mental health providers, and their possible impact on military members and beneficiaries across 26 states. As a clinician, military spouse and advocate, I am committed to ensuring our community is empowered to navigate these changes effectively, and confidently.
Dispelling Myths and Promoting Clarity As we move forward, it is essential to monitor the progress of this transition closely and maintain ongoing dialogue to address emerging challenges. Our shared goal is to ensure that service members, veterans, and their families continue to receive the exceptional healthcare they deserve, with minimal disruption and maximum confidence in the system. With the dedication of the TriWest team and the support of the broader community, I am confident that we can overcome these challenges together. Current Landscape and Transition Overview On Thursday, December 26, 2024, I had the opportunity to meet with Mr. David McIntyre, CEO of TriWest, and Ms. Donna Hoffmeier, Senior Vice President of Strategic Communications & Advocacy. The focus of our discussion was the recent transition of TRICARE West Region services from Health Net Federal Services (HNFS) to TriWest, a move that represents both challenges and opportunities. One of the primary topics we discussed was the potential for disruptions in care continuity. Data I collected, via a survey of clinicians (primarily in the Colorado service area), and shared with TriWest leadership, highlighted several critical areas of focus: Network Transition Status
Provider Capacity Analysis Among fully credentialed providers surveyed:
TriWest's Strategic Response Leadership commitment demonstrated a clear commitment to addressing transition challenges through:
Operational Excellence TriWest's track record includes:
Provider Information and Resources Mr. McIntyre emphasized that TriWest is working with an expedited process for any providers who have not yet joined the network. Ms. Hoffmeier later provided the following statement, "A provider can be added in as little as seven days or up to 45 days, depending on the provider's engagement and submission of complete information for contracting and credentialing,". Hoffmeier also clarified that providers who were previously certified with HNFS can remain certified as out-of-network (OON). "There is no action required by the provider," she stated, further alleviating potential concerns about administrative burdens. With their being 26 states involved, this provider did inquire about the process of joining the network, attempting to seek clarity around the rumors that different states may have different policies in this area. Ms. Hoffmeier provided the following information, to be applied to all Tricare/TriWest providers on the West. Providers in all states can visit the MHS Contract Transition page for more details: Providers can join the network through: 1. Completing the Join Our Network form at tricare.mil/west 2. Submitting required credentialing documentation 3. Completing the contracting process Claims Submission Options Two primary methods are available: 1. Electronic Submission (Payer ID 99726):
*Please be advised that the current TriWest states the following about payment turnaround time: "TriWest will make best efforts to process Clean Claims within thirty (30) days of receipt and will make payment directly to Provider for Covered Services rendered by Provider to Beneficiaries in accordance with the terms of the Reimbursement Exhibit." Provider Support Resources Providers can access, in Availity:
Transition Support and Continuity of Care Immediate Provisions If you are a TRICARE network provider:
For TRICARE Prime Enrollees If you are no longer a TRICARE network provider:
For Care Not Requiring Pre-Authorization Patients may keep seeing their provider and pay TRICARE Prime copayments. Starting April 2, 2025, if the provider is still a non-network provider, they patient may have to pay point-of-service fees and file a claim when seeing a nonparticipating, non-network provider. For TRICARE Select Enrollees For Care That Does Not Require Referrals or Authorizations (e.g., Mental Health Care) As of January 1, 2025:
Patients with Pre-Authorizations Extending Past January 1, 2025
For Care Not Requiring Pre-Authorization Starting Jan. 1, 2025, patients with TRICARE Select will need to see a TRICARE network provider. If they do not, they will likely pay more out-of-pocket. Patients may also elect to pay up front and file a claim when seeing a nonparticipating, non-network provider. Other provisions in place by TriWest
Rules may vary by plan options (TRICARE Prime, TRICARE Select and TRICARE For Life). NDAA Section 714 Implementation Recent conversations in this area have reinforced my respect for the leadership at TriWest and their willingness to engage in open and constructive conversations about these complex issues. It also underscored the importance of transparency and proactive engagement in navigating transitions of this scale, which is a great stepping stone to opening discussion around the recent passing of an amendment to Section 714 of the National Defense Authorization Act (NDAA), which allows military members and beneficiaries to keep their TRICARE providers for telehealth/teletherapy regardless of their station or deployment location. This legislation is a significant step toward addressing mental health care disparities within the military community, leveraging telehealth and licensure portability to expand the reach of essential services. Key Highlights of SEC. 714 Expansion of Licensure Portability:
Telehealth Health Services:
Conditions Set by the Secretary of Defense: Providers must meet the following conditions to be eligible under this provision:
Regulatory Framework:
Implications:
Recommendations for Providers
Conclusion The transition to TriWest and implementation of NDAA Section 714 represent significant steps toward improving military healthcare delivery. While challenges exist, the demonstrated commitment to provider support and care continuity suggests a positive trajectory. Providers are encouraged to actively participate in the transition process and provide feedback to ensure optimal implementation of these changes. It is essential for providers to recognize the significant role they play in supporting those who may not be working on the forefront of our community. During my conversation with Mr. McIntyre, I greatly appreciated his humility in acknowledging that he is not a clinician, is not directly involved in ground-level clinical operations, and does not have a complete understanding of our environment and practice realities. This humility underscores his genuine interest in receiving feedback about what is working well and what requiresimprovement, a process that relies on open and honest communication from our community. This principle also applies to the development of policy and regulation of NDAA Section 714. Leading up to the 180-day deadline, there will be ongoing discussions about how these provisions will impact clinicians, including their scope of practice, geographic reach (such as transcontinental considerations), and other critical factors. It is imperative that our community has the opportunity to submit questions and provide feedback to guide legislators in shaping these policies effectively. If such an opportunity arises, I strongly encourage providers to actively participate in this process. By contributing their perspectives and asking thoughtful questions, providers can help ensure that these legislative provisions are developed with input from diverse experiences and viewpoints, ultimately benefiting all stakeholders. Author: Dr. Courtney Barber, PsyD, LMFT, AAMFT-S --- *Note: This document reflects information as of January 1, 2025 and will be updated as new developments occur. * Web Resources TriWest “Join Our Network” form 10 USC 1094: Licensure requirements for health-care professionals H.R.5009- Servicemember Quality of Life Improvement and National Defense Authorization Act for Fiscal Yar 2025 www.Availity.com Tricare.mil
0 Comments
|
AuthorDr. Courtney Barber, PsyD, LMFT, AAMFT-S is a Psychologist and Licensed Marriage and Family Therapist with over 22 years of experience in the healthcare field. As the founder and owner of Barber Family Counseling & Wellness, she provides essential mental health and wellness services across Colorado and Nevada. A dedicated advocate for accessible mental health services, Dr. Barber is passionate about improving community well-being and addressing disparities in mental health care access. She is particularly committed to advancing military access to care, ensuring service members and their families receive the mental health support they need. Her expertise spans clinical practice, organizational psychology, and workplace well-being, empowering individuals, families, and organizations to achieve resilience, personal growth, and professional success. Deeply connected to the military community, Dr. Barber has served as a Key Spouse (now Key Support Liaison) for various Squadrons and Deltas. She is dedicated to mentoring military spouses and empowering them to pursue their passions alongside military life. Additionally, Dr. Barber plays a pivotal role in supporting the Space Force leadership’s goals, advocating for innovative ways to address the unique challenges faced by its members and their families. As a respected speaker, Dr. Barber frequently addresses topics such as mental health, organizational structure, and job satisfaction at conferences and events. Her work reflects a vision of holistic wellness and empowerment, promoting positive change in both community and business settings. ArchivesCategories |
RSS Feed