Tricare Prime vs Tricare Standard benefits

There is a difference between TRICARE Prime and TRICARE Standard benefits for beneficiaries.  The following is information to help you understand both programs:

TRICARE network providers sign a contract with Humana Military to provide care for TRICARE beneficiaries and agree to file claims.

TRICARE Prime enrollees are treated under a health maintenance organization-style model and are assigned to primary care managers (PCMs).  Beneficiaries and their PCMs are responsible for following the referral process when additional health care services are needed.

TRICARE Standard enrollees can choose to see any TRICARE-authorized provider, with no referral necessary.  TRICARE Standard patients who elect to see network providers for their care are using the TRICARE Extra Benefit, which offers lower out-of-pocket costs.  The TRICARE Extra option is similar to a preferred provider organization model.  Humana Military features listings of network providers to beneficiaries through the “Find a Provider” feature at www.humana-military.com

If you are a network provider and would like more information about the TRICARE Standard and TRICARE Extra program, you may view the TRICARE Provider Handbook or other materials posted to the provider portal at www.humana-military.com.  You may also contact your Humana Military provider relations representative for assistance.

If you are treating TRICARE Standard patients and have questions about issues such as collecting out-of-pocket payments or determining if deductibles have been met, you can use the “Check Eligibility” feature on the secured provider portal.  The feature also includes information about patients’ other health insurance (OHI), if it is on file.  Don’t forget, most OHI will be the primary payer for TRICARE patients, so you will need to bill the OHI first.

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