Humana military form 2025

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  1. Click ‘Get Form’ to open the Humana Military form in the editor.
  2. Begin by entering the Sponsor’s Name at the top of the form. This is essential for identifying the request.
  3. Fill in the Date of Request using the MM/DD/YYYY format to ensure clarity on when the request was made.
  4. Provide the Sponsor’s SSN, ensuring accuracy as this information is crucial for processing your request.
  5. Enter your phone number for any follow-up communication regarding your waiver request.
  6. In the Reason for Disapproval section, clearly state your justification if applicable, and provide details in the Reason for Request field to support your waiver application.
  7. Sign and date at the bottom of the form to validate your submission before sending it via mail or fax to Humana Military.

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As a federal lien, TRICARE has substantial bargaining power and generally seeks reimbursement for the total amount paid for treatment. With this being said, TRICARE does allow for adjustments and can be reduced or waived if justice requires.
Some diagnosis codes may indicate an injury or illness which a third party may have caused. When the TRICARE contractor gets claims with these types of diagnosis codes, the contractor will send you a Statement of Personal Injury Possible Third Party Liability form (DD Form 2527) to fill out.
Want to know how to call TRICARE? Regional ContractorsPhone Number TRICARE East Humana Military (East Region Contractor) 1-800-444-5445 TRICARE West TriWest Healthcare Alliance 888-TRIWEST (874-9378) TRICARE Overseas International SOS (Overseas Contractor) Country specific phone numbers
Examples of third-party claims include cases where a customer is injured due to hazardous equipment owned and maintained by a third-party vendor as well as cases involving faulty design or manufacture of products that cause injury.
Your regional contractor will send you the Statement of Personal Injury-Possible Third Party Liability (DD Form 2527) if a claim is received that appears to have third-party liability involvement. You must complete and sign this form within 35 calendar days.
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If a necessary service is not available from either the military hospital or clinic or the beneficiarys Primary Care Manager (PCM), a referral is required. Some procedures and services, including hospitalization and ABA services, require prior authorization from Humana Military.

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