<p> TRICARE HELP E-MAIL SERVICE (THEMS) NEWSLETTER SEPTEMBER 2003 Volume 2, Issue 9 [email protected] “Helping to Understand”</p><p>TRICARE Help Prime Remote (TPR) and Management Activity Newsletter TPR for ADFMs (TMA) has developed a This newsletter is a (TPRADFM). This search engine to show the publication of the Newsletter describes some zip codes that are TRICARE Help E-mail of the key issues considered remote. The Service, operated by the surrounding the use of TPR search engine is part of the U.S. Army Medical and TPRADFM. For a TPR website at the link in Command in San Antonio, more complete discussion, the previous paragraph. Texas. you should read the Prime Active Component (AC) Remote Handbook. Here is sponsors must live and THEMS a link to the TPR web page: work in a TPR zip code to http://www.tricare.osd.mil/t be eligible for TPR. pr/. Click on the web link Reserve Component (RC) What is THEMS? to view or print the entire sponsors who are activated THEMS is a free e-mail Handbook. Since personal on orders for more than 30 service that provides timely circumstances may have an days will be eligible for responses to TRICARE impact upon the choice of TPR if their mobilization questions. Clinical issues enrollment options, site is in a TPR zip code. should be referred to your sponsors or family TPR enrollment is not primary care provider. The members should always automatic, but it is e-mail address is: feel free to contact THEMS mandatory, so enrollment TRICARE_help@amedd. or one of the other should be initiated upon army.mil. customer service inprocessing at the new alternatives to consider duty station or mobilization their personal situation. site. If the duty station (for Click here to AC) or mobilization site send your TRICARE Eligibility (for RC) is not in a TPR zip questions, concerns, or First off, it is important to code, the sponsor must comments. understand what qualifies enroll in TRICARE Prime as a remote location. rather than TPR. Tips for Getting Care Service members and their ADFMs who reside with a While Stationed or families who live or are TPR-eligible AC sponsor Living in a Remote stationed in the vicinity of a may enroll in TPRADFM if they choose. Enrollment is Area military treatment facility (MTF) are normally able to not mandatory, but family members who choose not to Active duty service use the MTF to satisfy their health care needs. Zip enroll must use TRICARE members (ADSMs) and Standard or Extra and pay eligible family members codes more than about 50 miles from a MTF are the applicable deductibles (ADFMs), living and and cost shares associated working in remote areas, considered to be in a remote area in which TPR with those enrollment continue to have questions options. If the ADFM about the use of TRICARE and TPRADFM are available. TRICARE moves from the sponsor's residence, they are no sponsor’s servicing Your PCM will either treat longer eligible for TPR and personnel office, you can you or help you secure a must use either TRICARE update some information referral and authorization Standard or Extra. through this website: for specialty care. The The family members of RC http://www.tricare.osd.mil/ HCF documents the sponsors who have been deers/default.cfm. For authorization by placing an activated on orders for 30 enrollment forms for both entry into the claims days or more are eligible TPR and TPRADFM, you processing database. If the for TPRADFM if they live can use the TPR website PCM does not contact the at the address (in a TPR zip link in the first paragraph. HCF for an authorization, code) where they resided the patient is responsible with the RC sponsor before Selection of Primary Care for initiating contact with the Service member left for Manager (PCM) the HCF. The access their home station, If there are available standard for specialty care mobilization site, or network PCMs within is about a 1-hour drive. If deployment location. If the about a 30-minute drive of there is a network specialist family moves to another your residence, TPR or available within access address, even in the same TPRADFM enrollees must standards, that is normally zip code, TPRADFM select one of the network the provider you must use. eligibility will end and they providers as their PCM. Failure to secure the must use either TRICARE For help finding a PCM, required authorizations for Standard or Extra. you can call a health care TPRADFM specialty care TPRADFM enrollment is finder (HCF) for your will result in a point-of- optional. If the AC or RC region. The telephone service claim with a $300 ADFM wishes to use non- numbers start on page 51 of outpatient deductible and a network providers for the Prime Remote 50 percent cost share. personal reasons, or if the Handbook. You can also TPR-enrolled ADSMs who family has other health find a provider using the do not obtain the required insurance through either the TRICARE Provider authorizations will have RC sponsor or AC/RC Directory at this link: their claims denied. If this spouse, the best option may http://www.tricare.osd.mil/. happens, the ADSM should be to use TRICARE Just click on your region on call the Military Medical Standard or Extra. In most the map and go to the Support Office (MMSO) at situations, however, Network Provider 1-888-647-6676 to speak to TPRADFM will be the Directory for your region. the appropriate Service most advantageous option If there is no TRICARE Point of Contact (SPOC). for most eligible family network in your area, you members. It is important may use any authorized Claims that information in the provider as your PCM. In most cases, your Defense Eligibility Either the HCF or THEMS providers will file your Enrollment System can help you find a PCM. claims for you. If they do (DEERS) properly reflects not, you can file the claim the address and eligibility Primary and Specialty yourself using a DD form information on all Service Care 2642. Be sure to attach an members and their families. Under TPR and itemized bill to your claim. Although this information TPRADFM, you must go to Here is a link with is normally controlled and your PCM for all non- information to help you file updated through the emergency health care. your claims: 2 http://www.tricare.osd.mil/ Probably the most claims/. important thing to remember about health care Dental Care in a remote area is to use Dental care for the TPR support functions such as ADSM is provided under the HCF, the Beneficiary the provisions of the Counseling and Assistance Triservice Remote Dental Coordinator Program (RDP) (http://www.tricare.osd.mil/ administered by the BCACDirectory.htm), the MMSO. Since there is no MMSO, or THEMS. If preferred dental network something is causing you a for the RDP, active duty problem, ask for help early personnel may select any rather than waiting for a licensed dentist in the area. small issue to grow into a It is important to remember serious problem. that any routine dental procedure costing more than $500 and all specialty Click here to care must be pre- send your TRICARE authorized. For detailed questions, concerns, or instructions on the use of comments. the RDP, go to the MMSO website: http://mmso.med.navy.mil/. Family members should use the TRICARE Dental Program administered by United Concordia. You can find information on the program at: http://www.ucci.com/was/u cciweb/tdp/tdp.jsp. The MMSO was established to help the service member coordinate both medical and dental care while traveling or stationed in an area outside of the normal care available at the military medical or dental treatment facility. Family members, however, should coordinate their care through the TRICARE HCF rather than the MMSO. </p><p>3</p>