Line of Duty - TRICARE West

Members of the National Guard and Reserve who become ill or injured while on active duty may be eligible for line of duty (LOD) care, also known as ... HNFS.comTRICAREWestProviderAuthorizationsLineofDuty PublicTools BenefitsA–Z IsApprovalNeeded? NetworkProviderDirectory Non-NetworkProviderDirectory CheckCredentialingStatus SecureTools Eligibility&Deductible PatientOHI PrescriptionMonitoringProgram IsApprovalNeeded? SubmitanAuthorization AuthorizationStatus SubmitaClaim ClaimStatus UploadaDocument ClaimsReport RequestElectronicRemits View&PrintRemits Recoupments EFTRegistration TRICAREProviderConnect-PatientMedicationList TRICAREProviderConnect-PatientView NominateaBeneficiaryForCaseorDiseaseManagement PCMEnrolleeRoster UpdateDemographics UpdateSpecialty SecureInbox AskUsSecureEmail MyAccount LineofDuty MembersoftheNationalGuardandReservewhobecomeillorinjuredwhileonactivedutymaybeeligibleforlineofduty(LOD)care,alsoknownasnotificationofeligibility(NOE)forCoastGuardmembers. EligibilityforCare Lineofduty careisspecifictotheacquiredinjuryorillness.Asaresult,thebeneficiarywillnotshowasTRICARE-eligibleintheDefenseEligibilityEnrollmentReportingSystem(DEERS).Lineofdutyeligibilityisabranchofserviceresponsibilityandinitiatedthroughthebeneficiary’sunitmedicalrepresentative,notHealthNetFederalServices,LLC(HNFS) orDEERS. ToshowauthorizationforLODcare,theservicemembershouldhaveinhand,hisorherordersormustersheet,alsoknownasanattendanceroster,andadocumentissuedbytheunitrepresentativeshowingtheservicemembercanreceivecarefortheinjuryorillnessspecifictoservice.Iftherearequestionsorfurthereligibilityverificationisrequired,calltheDefenseHealthAgency–GreatLakes(DHA-GL)at1-888-647-6676. Itisthebeneficiary’sandhisorherunitmedicalrepresentative’sresponsibilitytoensureLOD/NOEeligibilitydocumentsaresubmittedtoDHA-GL,priortohisorherappointmentwithyou.ThesedocumentsarelocatedontheDefenseHealthAgency'swebsite: TRICARELODpage DHA-GLwebsite HealthCareCoverage Wheneverpossible,militaryhospitalsandclinicsprovidecaretoNationalGuardandReservememberswithLODconditions.However,militaryhospitalsorclinicsorDHA-GLmayrefertoTRICARE-authorizedcivilianproviderswhenanearbymilitaryhospitalorclinicisnotavailabletodeliverorcoordinatecare.Lineofduty coverageisseparatefromanyotherTRICAREcoverageineffect,suchas: TransitionalAssistanceManagementProgramorTransitionalCareforService-RelatedConditionsprogram TRICAREReserveSelect Note:BeneficiarieseligibleforLOD/NOEmayshowineligibleinDEERSforTRICAREcoverage,sincetheyareonlyapprovedforcarerelatedtothatinjuryorillnessincurredwhileonduty.  ObtainingApprovalforCare TheLOD/NOEdeterminationisestablishedbybranchofservice-specificpolicyandusedtodocument,establish,manageandauthorizehealthcareforNationalGuardandReservemembersinjuredwhileonweekenddrilldutyorwhileontrainingorders.Reviewthestepsbelowtoobtainapprovalforcare:  InitialhealthcareforanLODinjuryorillnessiscoordinatedbythebeneficiary’sunitmedicalrepresentative.Themilitaryhospital/clinicoverseeingthebeneficiary’sLODinjuryorillness,orDHA-GL,willsubmitarequesttoHNFSforreviewwhencaremustbereceivedoutsideofthemilitaryhospital/clinic.  HNFSwillreviewtherequestandapprovecareasappropriate.  Thereferralsubmittedbythemilitaryhospital/clinicisvalidfor180daysandDHA-GLisvalidfor365days.Ifcontinuedcareisnecessarybeyondtheapproval: Within theepisodeofcare(180/365):TheservicingprovidercansubmitarequesttoHNFSforreview.  Beyond theepisodeofcare(180/365):Theservicingprovidershouldprovidethebeneficiarywithanorderforcontinuedcare.Thebeneficiarywillthenneedtocoordinatethecontinuedcarewithhisorherunitmedicalrepresentative.Ifadditionalcaremustbereceivedfollowingtheexpirationoftheinitialreferral,,thebeneficiary’sunitmedicalrepresentativeorDHA-GLwillsubmittherequireddocumentationtoHNFSforprocessing,andanapprovalwillbeissued.  Note:TRICARE-authorizedprovidersshouldnotreachouttothemilitaryhospital/clinicorDHA-GLforadditionalinformation.Instead,contactHNFSandwewillassistandprovideguidanceasneeded. Emergencyandurgentcareiscoveredifthebeneficiaryhasaseriousillnessorinjuryduringweekenddrilldutyorwhileontrainingorders.PriorauthorizationfromHNFSorDHA-GLisnotrequiredforemergencyorurgentcare. ClaimsSubmission CivilianprovidersshouldsubmitallclaimsforLODcaretoHNFS/PGBAunlessotherdirectionsareprovidedontheLOD-writtenauthorizationorrequestedbytheNationalGuardandReservemember’sunitmedicalrepresentative. HealthNetFederalServicesforwardsclaimsnotreferredbyanMTForpre-approvedbyDHA-GLtoDHA-GLforreview.WhensubmittingclaimsforaNationalGuardandReservememberwithanLODcondition,thehealthcareservice(s)listedontheclaimmustbedirectlyrelatedtotheconditiondocumentedontheLOD-writtenauthorization. IfDHA-GLdeniesaclaimforeligibilityreasons,theprovider’sofficeshouldbilltheNationalGuardandReservemember.Oncetheappropriateeligibilitydocumentationissubmitted,DHA-GLmayapprovethepayment.