Network providers have signed a contract with Humana Military Healthcare Services (HMHS) and are credentialed as part of our network. They have (in most cases) agreed to accept a negotiated rate as payment in full, and they have agreed to submit their TRICARE patients' claims to PGBA, the claims processor for this region. PGBA will send the claim payment directly to the provider.
Non-network providers are not contracted by HMHS. TRICARE patients who go to non-network providers pay a larger share of the TRICARE maximum allowable charge and may have to file their own claims.
Network providers have agreed to accept negotiated rates as payment in full (they are prohibited from balance billing TRICARE beneficiaries) and they have also agreed to file claims on behalf of TRICARE beneficiaries.
When you enroll in TRICARE Prime you select or are assigned to a primary care manager (PCM), who provides or coordinates all of your health care. As your personal physician, your PCM becomes knowledgeable about your medical history and familiar with your unique health care needs. Your PCM will follow your care throughout any needed treatment and can recommend preventive care based on your medical history.
A PCM may be a general practitioner, family practitioner, internist or pediatrician. Depending on your location and/or military treatment facility requirements, your PCM may be an individual provider or a group of providers in the MTF or civilian provider in your community. You may choose a different PCM for each member of your family.
You may select or are assigned to a civilian or primary care manager (PCM). If you live within 40 miles of a military hospital or clinic, you may be required to select a military PCM.
Before you list a PCM as a choice on your enrollment form, we suggest you call the PCM's office to confirm that the doctor is still accepting new TRICARE patients.
You will receive a letter with your Prime Enrollment card(s) indicating PCM assignment for you and each member of your family. Please write the specified PCM's name on each Enrollment card in pencil, not pen, so that it can be changed if necessary.
You may change your PCM at any time providing the new PCM is accepting patients and your request complies with local MTF guidelines. Once you’ve located the new PCM in the Humana Military Provider Directory, complete the TRICARE Prime Enrollment/PCM Change form and turn it in at your local TSC or mail it to the address shown on the form.
Changing your PCM at an MTF will be effective immediately. If you’re changing a civilian network provider or switching from an MTF provider to a TRICARE network provider, the change will be effective based upon when the form is processed: on or before the 20th of the month, the change will be effective on the first day of the following month; after the 20th of the month, the change will be effective on the first day of the next month. (For example, on or before June 20th, the effective date is July 1st - after June 20th, the change is effective August 1st.)
If you’re residing in an area that is covered by a contractor’s civilian provider network, you have to choose a primary care manager (PCM) from that contractor’s provider directory at the time of enrollment. The Humana Military provider directory can be found on our Web site at www.humana-military.com or you can call 1-800-444-5445 to receive assistance in choosing your PCM.
If you live in an area that isn’t covered by Humana Military’s civilian provider network, you are free to use any TRICARE authorized provider as your PCM or for any required specialty care. To locate a TRICARE authorized provider, call 1-800-444-5445 or contact the closest beneficiary counseling and assistance coordinator (BCAC).
