Even critics admit the system has made progress from a slow start-up in many parts of the country. For instance, it is easier to get service provider representatives on the phone in many Tricare regions. Claims processing has improved. The goal for contractors to hit was 75 percent of claims within the three-week time period. How true, say some recipient groups.
Claims remain one of their biggest areas of concern.
A cumbersome and unresponsive claims process is a primary cause of frustration for both beneficiaries and civilian Tricare providers, said Torsch, representing the Military Coalition. Providers often face months of delays in getting paid and have a difficult time even getting in touch with Tricare claims processors to discuss their problems, said Torsch. It is the single most frequently mentioned reason providers opt out of the system or decline to join it in the first place, she said. It was a major cause, for instance, of the recent withdrawal of Group Health Cooperative of Puget Sound, Wash., as a network provider in Tricare Region 11. The Military Coalition believes that Tricare's claims processing goals are not adequate to protect service members and their families.