Individual Case Management
On 1 October 2004 the TriCare system underwent a massive management restructuring. Part of this process was the elimination of local on Base/Post RN Case Managers. All case management now occurs at the Regional level.
What is Case Management and Why Do I Need It?
A Case Manager is a specifically trained RN assigned to assist TriCare beneficiaries who have complex, catastrophic, short term and/or long-term care needs.
Currently TriCare Case Managers May:
- Identify and facilitate needed services and equipment in collaboration with the beneficiary's PCM.
- Decrease provider's administrative tasks by assisting with referrals, authorizations, and locating specialists when needed.
- Educate beneficiaries about TriCare benefits.
- Educate beneficiaries about his/her disease process.
- Promote positive lifestyle changes that may affect the beneficiary's disease (e.g., diet, exercise, encourage compliance with treatment plans, stress management and the importance of keeping doctor/therapy appointments).
- Provide a point of contact to assist both beneficiaries and PCMs with problem solving, act as a beneficiary advocate, and assist in communicating with caregivers on behalf of the beneficiary.
- May refer beneficiaries to the ECHO program (see below).
TriCare now requires a PCM referral for Case Management Services. If you believe you may qualify for Case Management Services discuss this option with your PCM or civilian physician. He/she can find a Case Management Patient Referral Form under the Provider Connection "Find A Form" link on your regional TriCare web site. To submit the form the PCM must print the form, fill out the required information and submit forms via fax to the appropriate Regional TriCare Office. It is recommended these forms be then filed with your dependant's medical record, should the form be needed again.
Case Management staff will review Case Management requests. Once a determination for services has been made a letter of acceptance or denial will be issued to the individual and contact by a Case Manger will be made.