06.16.21

Lankford Pushes for Health Care Access for Oklahoma Veterans

WASHINGTON, DC – Senator James Lankford (R-OK) today sent a letter to the Director of the Defense Health Agency, Lieutenant General Ronald Place, following concerns raised to his office by Oklahoman veterans that TRICARE rules do not allow veterans to submit electronic forms and documentation, particularly for Express Scripts, despite being able to submit them electronically in other areas of health care.

Lankford wrote in his letter, “TRICARE rules require beneficiaries to submit relevant forms and documentation via fax or physical mail. There is no electronic option for submitting these documents to the appropriate TRICARE contractor, and while managed care support contractors Humana and HealthNet have e-portal features to check a claim’s status, Express Scripts does not have this capacity.

“Service members and their families in Oklahoma have contacted me about this issue expressing the difficulty of having to submit these claims via paper means,” Lankford continued in the letter. “Therefore, I respectfully urge you to implement an electronic submission option to improve this outdated process and provide service members and their families with swift reimbursement of their claims.”

A copy of the letter can be found HERE or below.

Dear LTG Place:

I am writing to express my concern regarding the lack of electronic submission process for TRICARE reimbursement claims. As you know, beneficiaries with Other Health Insurance (OHI) are currently required to submit their claims for reimbursement for out-of-network pharmaceutical services via physical mail or fax as there is not an option to submit claims electronically. 

While the Department of Defense (DOD) is not required by statute to use an electronic claims or reimbursement process for the TRICARE program, those features are determined via internal regulation and TRICARE policy. Based on these policies and contractual requirements with the TRICARE Pharmacy contractor, the Defense Health Agency (DHA) only requires “cashless, claimless” processing of claims for network pharmacies. While out-of-network pharmacies can submit reimbursement claims to TRICARE for patients, this is not a common business practice in the insurance industry. As a result, the responsibility to file reimbursement claims for out-of-network services falls solely on the patient.

TRICARE rules require beneficiaries to submit relevant forms and documentation via fax or physical mail. There is no electronic option for submitting these documents to the appropriate TRICARE contractor, and while managed care support contractors Humana and HealthNet have e-portal features to check a claim’s status, Express Scripts does not have this capacity.

Service members and their families in Oklahoma have contacted me about this issue expressing the difficulty of having to submit these claims via paper means. Therefore, I respectfully urge you to implement an electronic submission option to improve this outdated process and provide service members and their families with swift reimbursement of their claims.

This modernization effort will ultimately benefit the service members, provide ease of reimbursement for beneficiaries with healthcare providers that do not use a TRICARE pharmacy network, and usher the claims process into the 21st century. Thank you for your attention to this matter and I look forward to hearing from you.

In God We Trust,

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