What services are offered?
A: Beneficiary Counseling and Assistance Coordinators (BCAC): BCAC’s provide individual counseling on all TRICARE Program options available based on your beneficiary category. If you are eligible for TRICARE and need assistance understanding which TRICARE option best fits your needs please call 301-677-8982 to schedule an appointment for individual assistance.
Debt Collections Assistance Officers (DCAO): DCAO’s assist TRICARE eligible beneficiaries determine the validity of collection notices and/or adverse credit reports related to civilian care received while covered under TRICARE. For individual assistance related to a debt collection notice and/or an adverse credit report please call 301-677-8982 to schedule an appointment. Please bring a copy of your collection notice or adverse credit report in addition to any provider billing statement(s) you may have received.
What is TRICARE?
A: TRICARE is the Department of Defense’s worldwide health care program available to beneficiaries from any of the seven uniformed services – the U.S. Army, U.S. Navy, U.S. Air Force, U.S. Marine Corps, U.S. Coast Guard, U.S. Public Health Service Commissioned Corps, and the National Oceanic and Atmospheric Administration.
How do I know if I am eligible for TRICARE?
A: Eligibility for TRICARE is based on information in the Defense Enrollment Eligibility Reporting Service (DEERS). Proper registration is the key to receiving timely and effective TRICARE benefits. All sponsors (Active Duty, Retired, National Guard, or Reserve) are automatically registered in DEERS. However, sponsors must register eligible family members in DEERS. It is important for sponsors to keep information in DEERS records up to date. Please call 1-800-538-9552 for information regarding TRICARE eligibility or to update your personal information.
I’m active duty; do all of my family members have to be enrolled in TRICARE Prime?
A: Since you are active duty you must enroll in a TRICARE Prime option. However, TRICARE Prime is optional for your family members. If they choose not to enroll in TRICARE Prime they will be covered under TRICARE Standard/Extra and applicable cost shares and deductibles will apply.
In general beneficiaries use TRICARE Prime because it offers lower out of pocket expenses and their care is managed. Active duty family members typically choose to use TRICARE Standard/Extra if they have other health insurance or want to choose their own TRICARE Authorized providers within the civilian community and don’t mind the out of pocket expense. If your family members are enrolled in TRICARE Prime (in the North Region), and they want to use TRICARE Standard/Extra, they will need to submit a disenrollment form the TRICARE North. For more information please contact TRICARE North at 1-877-874-2273 or stop by the TRICARE Service Center at the Kimbrough Ambulatory Care Center. If you need additional assistance please contact the Health Benefit Advisor at 301-677-8982.
How can I change my Primary Care Manager (PCM)?
A: While in the TRICARE North Region, beneficiaries enrolled in TRICARE Prime have several options for requesting a PCM change:
Note: ADSM may only use the beneficiary web enrollment portal to change PCM’s while enrolled in TRICARE Prime Remote.
Telephone: Call TRICARE North customer service at 877-874-2273 and follow prompts.
Mail: Complete a DD Form 2876, TRICARE Prime Application and PCM change Form, and mail to:
Health Net Federal Services, LLC
PO Box 870143
Surfside Beach, SC 29587-9743
PCM changes can take several business days to process through the mail and the beneficiary web enrollment portal. Please verify with TRICARE North that your PCM request is complete prior to scheduling your appointment with your new Primary Care Manager.
Beneficiaries using the U.S. Family Health plan may use the beneficiary web enrollment portal www.dmdc.osd.mil/appj/bwe/ (Log on and password required) to manage their Prime enrollment and Primary Care Provider requests or may call the U.S. Family Health Plan customer service center at 1-800-808-7347 to change their Primary Care Provider.
I’m getting ready to retire from the military, how can I find out if TRICARE Prime is available where I plan on living?
A: To find out if TRICARE Prime is available where you plan on living you should contact the regional contractor involved. To find out which contactor services your region please visit www.tricare.mil, answer three demographic questions, and click submit. The website will determine the regional TRICARE contractor responsible based on the zip code you enter and will provide the contractors contact information for you to explore your options. Please note that TRICARE Prime is only available to military retirees and their eligible family members at stateside locations to include Hawaii and Alaska within PRIME Service Areas (PSA’s). TRICARE Prime coverage is not available for military retirees and their family members residing overseas.
I retired from the military. My wife and I are turning age 65 what steps must we take to ensure we remain eligible for TRICARE?
A: Military retirees and their family members entitled to premium free MEDICARE Part A, due to age or disability must purchase MEDICARE Part B to remain eligible for TRICARE. Your coverage will change to a program called TRICARE for Life. If you are approaching age 65 or you become eligible for premium free MEDICARE Part A due to disability prior to age 65 please call 301-677-8982 to schedule an appointment with one of our Health Benefit Advisors for individual assistance regarding your benefits.
I’m covered under a civilian health plan, how does that impact my TRICARE benefit?
A: Other health insurance (OHI) is defined as any non-TRICARE health insurance that is not considered a supplement. If you have other health insurance you must follow the rules of that plan, including its referral and authorization requirements. (Please note that certain TRICARE authorization requirements also apply for certain services)
Your OHI is considered your Primary Insurance (Except for Active Duty Service Members). TRICARE pays second to OHI, except for Medicaid TRICARE Supplements, the Indian Health Service, or other programs or plans as identified by the TRICARE Management Activity.
You or your provider must file claims with your OHI before filing with TRICARE. Once your OHI determines the amount it will pay, a claim may be filed with TRICARE. Be sure to include a copy of your OHI’s payment determination (explanation of benefits), a copy of the itemized bill, and a TRICARE Claim form DD form 2876. Claims should be submitted to the appropriate regional contractor for determination. Remember to always keep your regional TRICARE contractor informed of the status of your OHI. This will make coordinating your benefits easier and will help reduce the likelihood of errors when processing your claims. To access the OHI questionnaire for your regional contractor please visit http://www.tricare.mil/mybenefit/home/Medical/OHI.
In addition you must also make Kimbrough Ambulatory Care Center aware of any OHI you may have. Kimbrough Ambulatory Care Center maintains a congressionally mandated Third Party Collection Program that authorizes Military Treatment Facilities (MTF) to bill other health insurance for medical services provided to Department of Defense beneficiaries. The Third Party Collection Program only applies to active duty family members, retirees and retiree family members with other health insurance.
The Third Party Collection Program will only bill your other health insurance company and they will pay benefits directly to Kimbrough. You will not be billed for any charges your OHI does not pay. It is important to know that claims filed for care you received in our facility that are a benefit of your insurance count toward meeting your yearly deductible and out of pocket maximum. Also, all monies recovered are kept locally and are used to enhance care, upgrade equipment, and maintain services at our facility. For more information about the Third Party Collection Program at Kimbrough please call 301-677-8121.
I’m new in the area, how can I find civilian dentists or dental providers that accept TRICARE?
A: If you are enrolled and using the TRICARE Dental Program for Active Duty Family Members, National Guard, Reserve and their Family Members you may visit www.tricaredentalprogram.com or call 1-800-866-8499 for assistance in locating participating dental providers.
If you are enrolled and using the TRICARE Retiree Dental Program you may visit www.trdp.org or call 1-888-838-8737 for assistance in finding participating dental providers.
Why am I receiving bills from civilian providers for my medical care?
A: The cost for care received from civilian sources is dependent on multiple factors. Some (not all) factors considered when processing claims include eligibility for TRICARE at the time care was provided, the specific TRICARE Program the beneficiary was covered under at the time services were rendered and the “rules” for that program, beneficiary category (Active Duty, Active Duty Family Member, Retiree, Retiree Family Member, National Guard or Reserve etc…), and any prior authorization requirements. For information on costs please visit http://www.tricare.mil/tricarecost.cfm.
Active duty service members and their family members as well as retirees and their family members not entitled to Medicare may register at www.mytricare.com to view their TRICARE North Explanation of Benefits and authorizations online. After receiving care from a civilian provider, it is important for you to review your TRICARE North Explanation of Benefits and contact TRICARE North at 1-877-874-2273 if you have any questions or concerns. For further assistance please contact one of our Health Benefit Advisors at 301-677-8982 to schedule an appointment to review the circumstances involved.
Please note: Beneficiaries entitled to Medicare to should register with www.medicare.gov and www.tricare4u.com to view their Medicare Summary Notices and TRICARE Explanation of Benefits or they may call Medicare at 1-800-633-4227 and WPS TRICARE for Life at 1-866-773-0404 for stateside claims assistance.
I received a notice from a collection agency and/or I have a negative credit report due to care I received from a civilian provider while eligible for TRICARE, what do I need to do?
A: Kimbrough Ambulatory Care Center has two trained Debt Collection Assistance Officers (DCAO) who stand ready to assist in determining the validity of the alleged debt. In order for our DCAO’s to assist, please provide a copy of the collection notice or an adverse credit report in addition to any other documents such as provider billing statements. To schedule an appointment with our Debt Collection Assistance Officers please call 301-677-8982. For a worldwide list of DCAO’s please visit http://www.tricare.mil/bcacdcao/.