New Tricare – HealthNet having many issues

Karen Lee

On January 1, 2018 Tricare was officially handed over to a new contractor- HealthNet. According to a recent Military Times article: providers and beneficiaries have been experiencing a less than pleasant transition. Providers are facing: denials, authorization failures, and credentialing delays that are directly impacting the patients. To top that, if you try and get answers, reaching out to HealthNet directly (calling the number listed on their website) will result in upwards of an hour or more on hold to speak with a representative. While it seems HealthNet has made some adjustments and is trying to help serve patients and providers more effectively, we can’t help but think is it too little too late?

Ponderosa has been working diligently to try and make this move as painless as possible on our providers, and the patients they serve. We started working on this transition when HealthNet first announced the move in July of 2017. We were able to make an impact, and help our providers, prior to any help from HealthNet directly. While we are still battling issues for our providers, we are happy to report we are seeing movement forward.  This is what a team of dedicated professionals is for! Below are some data points we have gathered.

  1. For our Mental Health: 35 claims on average per provider have been submitted. On average 34 out of 35 of those claims are paying within five business days.
  2. We have submitted over $39,000 worth of claim charges for our ABA Providers, $33,000 have been paid successfully.
  3. We have submitted orthopedic specialty procedure claims totaling $1,662.15, of that $1,008.99 and have paid within 60 days.
  4. We have submitted 77 credentialing applications. Of those 77 credentialing applications 63 have been approved. 50 of those applications were approved prior to Tricare going live.
  5. We have submitted approximately 16 ABA authorizations since the new Tricare launch, all authorizations were complete, and approved within 48 hours.

Visit our services page to see how Ponderosa can help your business eliminate some of the burdens that Tricare has caused today!