23rd MDG changes urgent specialty care request effective May 1 Published April 13, 2011 By 23rd Medical Group MOODY AIR FORCE BASE, Ga. -- The 23rd Medical Group has announced important changes to the local process and policy for obtaining emergency room, urgent care and medical specialty services for prime beneficiaries enrolled with the MDG. Historically, beneficiaries have been able to call and get a referral after the fact. Effective May 1, this option will no longer be available. Unless it is a true emergency, beneficiaries will require authorization from a MDG provider before seeking medical care. Emergency room services: Non-active duty beneficiaries do not require a referral to obtain emergency services. Emergency services prevent the loss of life, limb or eyesight. Should any prime beneficiary seek emergency room services for non emergent issues, they may incur point of service (POS) charges which include a $300deductible and 50 percent cost share. If you are having a true emergency, dial 911 or go to the closest emergency room. If you are unsure if your situation is a true emergency, call the appointment line 24 hours a day, seven days a week at 229- 257-2778 and you will be directed to appropriate care by the on-call provider. Active duty members must always contact their primary care manager by calling 229-257-2778 as soon as possible after an emergency room visit so appropriate authorization can be coordinated. Urgent care: All beneficiaries must contact the 23rd MDG prior to seeking urgent care services. If you are experiencing medical symptoms after duty hours that you feel could progress into an emergency situation, call the appointment line 24 hours a day, seven days a week, and you will be directed to the appropriate care. All Tricare prime beneficiaries must contact the 23rd MDG at 229-257-2778 prior to seeking urgent care. Failure to do so may result in the POS charges mentioned above. Your primary care manager or the on-call provider will direct you to the appropriate care. Please remember, if you are directed to a specialty care follow-up appointment from an emergency room visit or urgent care facility visit, you must obtain authorization for this specialty care before care is rendered outside the emergency room or urgent care setting. This can be accomplished by contacting your primary care manager team by calling the 23rd MDG at 229- 257-2778. Retroactive specialty care (non-emergent or urgent): Effective May1, the 23rd Medical Group will no longer authorize retroactive specialty care referral requests. Beneficiaries must have prior authorization before seeking specialty care in the network. This local change is in compliance with Chapter 1, Section 9.1 of the Tricare Policy Manual 6010.54M, which states, "Failure to obtain a primary care manager referral when one is required will result in the service being paid under point of service procedures with a deductible for outpatient services and cost-shares for in and outpatient services." To check on the status of any specialty care authorization, please call the referral management center at 229- 257-2778, the Tricare Service Center at 1-800-444-5445 or online at www.humana-military.com by clicking on the beneficiary tab and establishing a logon and password. Questions regarding covered benefits can be directed to the Tricare beneficiary counseling and assistance coordinator located in the referral management office at 229-257-4355 or 229-257-4932. Should you feel that you have extenuating circumstances regarding any denial of payment for emergency room, urgent care or specialty care services, a request for reconsideration should be submitted in writing and forwarded to our chief of medical staff through the utilization management department at the 23rd Medical Group, 3278 Mitchell Blvd, Moody AFB, GA, 31699. The department's phone number is 229-257-3010 if you have any questions concerning this matter.