HomePatient ResourcesMedical Management

Patient Resources

Medical Management

Medical Management (MM) program is multidisciplinary care team who communicates, documents, coordinate processes, and promote seamless care transitions and reduce fragmentation of MM activities across varied treatment settings to include direct care, purchased care and Department of Veterans Affairs (VA)

Subjects

  • Managed Care & Referral Network
  • TOP Prime and TOP Prime Remote Active Duty Family Members (ADFMs)
  • Medical Bills
  • Traveling Beneficiaries

Managed Care & Referral Network:

TRICARE Overseas Program (TOP) Prime and TRICARE Overseas Program (TOP) Prime Remote:

TOP Prime and TOP Prime Remote Active Duty Service Members (ADSMs) and Active Duty Family Members (ADFMs) have no out-of-pocket costs when getting covered health care services from your military hospital or military clinic Primary Care Manager (PCM) or when you have the appropriate referral and prior authorization for other care from network or participating purchased care sector providers.

To find a network provider, visit: http://www.tricare-overseas.com/beneficiaries/resources/provider-search

When seeing non-network, nonparticipating providers for covered health care services, expect to pay the full cost of care up front and file a claim for reimbursement. Overseas, there may be no limit to the amount that non-network, nonparticipating providers may bill, and you are responsible for paying any amount that exceeds the TRICARE-allowable charge.

The point-of-service (POS) option allows those using TOP Prime (except ADSMs) to pay additional out-of-pocket costs to get non-emergency health care services from any TRICARE-authorized provider without a referral. Out-of-pocket expenses you pay under the POS option are not applied to your yearly catastrophic cap. For more information about the POS option, go to www.tricare.mil/pointofservice

ADSMs require prior authorization for all inpatient and outpatient specialty care services.

Several of our Referral Management personnel also serve as Patient Liaisons. In this role, they help coordinate network appointments and inpatient admissions, after-hours patient transfers and admissions, translation services for network care, and consult results from network providers.

TOP Prime and TOP Prime Remote Active Duty Family Members (ADFMs):

ADFMs require prior authorization for all inpatient and outpatient specialty care services. ADFMs require prior authorization for outpatient mental health care visits or psychotherapy (this includes outpatient visits for substance use disorder (SUD)). Exceptions apply for psychoanalysis, electroconvulsive treatment and Transcranial Magnetic Stimulation (TMS) services.
International SOS has oversight and is responsible to the patients enrolled in TOP Prime Remote and TRICARE Select for claim processing. International SOS can be contacted on these following numbers: TRICARE Pacific Area: 81-98-970-4854 / DNS 315-645-4854 / From US 1-888-777-8343 or visit http://www.TRICARE-overseas.com.

Non-Enrolled TRICARE Patients with a Referral from a USNH Provider:

The RMC offers referral management assistance to patients who are NOT enrolled to USNH Japan as a TRICARE Prime patient if your referral originated from a USHN hospital. If you are not enrolled to TRICARE Overseas Program Prime Remote (TOP Prime Remote), TRICARE Select or utilize insurance benefits that are not part of the TRICARE program, and have a referral from a primary care provider, the RMC will assist with booking your appointment to one of the local providers. We can provide transportation and translation services to the first appointment only on a space available basis. All proceeding appointment transportation and translation services must be arranged and funded by the patient.

All other patients who are allowed care by USNH Yokosuka (e.g., NATO personnel, DoD affiliates, DoDs teachers) are not bound to providers in the TRICARE network maintained by International SOS.

For all patient categories, if the initial referral was generated by USNH Yokosuka, we will provide the follow up written translation services pertaining to the care you received in the network. Once the written translation is completed the original documentation will be scanned and placed into AHLTA your electronic health record.

Please Note: RMC staff does not contact, provide booking or transportation to providers outside the ISOS network. If the patient seeks care outside the International SOS network, it is the patient's responsibility to seek written translation services.

Medical Bills

If you are enrolled in TRICARE Prime, all necessary medical cost incurred during your Japanese hospitalization will be paid for by your TRICARE benefit. (Note: TRICARE Prime does not cover extra charges for the use of television, refrigerator or private room unless it is medically necessary). You may also be asked to purchase some personal items such as diapers, towels, support stockings, etc. at the hospital store at your own cost. Health Benefits Advisor can be contacted at 046-816-8992.

TRICARE will not cover birth certificates or death certificates

If you have TRICARE Select or other medical insurance, please be aware that Japanese hospitals are not able to bill your insurance companies directly. You as a patient must pay the entire medical bill to Japanese hospital in Yen at the time of discharge or soon after. You must then file a claim with your insurance company for reimbursement. Credit card payment is possible only at some hospitals. Most Japanese hospitals will only accept cash payments in Japanese Yen. When you make your payment, please make sure to receive an itemized receipt as it is necessary when you file a claim with your insurance company.

If you have an extensive procedure or are hospitalized for a long period, your bill may be quite large. Please consult the billing department at the Japanese hospital and your insurance company for assistance in making arrangements to pay the bill. Many hospitals will work with you to arrange a payment plan until you receive the reimbursement from your insurance company.

Some U.S. based insurance companies have Japanese agents who help arrange payments directly with Japanese hospitals. Please contact your insurance representative to verify your benefits and obtain information about the possible use of such agents to help with your bill.

If you have questions or concerns, please contact USNH Health Benefits Office for more information at 046-816-8992 (DSN 243-8992).

Traveling Beneficiaries

Are you planning to travel from your enrolled overseas region to another overseas location? Or, back to the United States? If so, there is important information you need to know about using your TRICARE program options while traveling. For more information, visit: http://www.tricare-overseas.com/beneficiaries/resources/traveling-beneficiaries

Birth Certificates for Newborns

When a baby was born at a Japanese hospital, his or her birth has to be reported to a Japanese City Hall.

Pre-submission:

You will receive your baby's birth certificated from the Japanese hospital. Only right side of the certificate is filled by the hospital personnel. The left side is left blank for the parents to fill in. The form has to be filled in Japanese. If you do not have anyone to fill the form for you, a case manager can assist you to complete the form.

Submission:

Once the form is complete, it needed to be submitted to the City Hall.
Along with the completed Japanese Birth Certificate, you will need:

Both parents' Passport or military ID if passport is not available (ORIGINAL)
Marriage Certificate (ORIGINAL)

Post-submission:

Once the birth certificate is submitted, it takes approx. 2 hours for them to process the paper. After 2 hours, you will need to request for a copy of Certificate of Acceptance of Birth Report (Shusshou jyuri shoumeisho). You will need this form for your baby's passport and SSN application. It costs 300yen per copy. Please bring Japanese yen and your passport or military ID for the personal verification. After you receive the certificate, a case manager will then translate the document in English.

Parking:

There is a parking structure crossed the street (left side of the City Hall). Please bring in your parking ticket with you so that it can get validated.

DEERS/TRICARE Enrollment:

Don't let your child lose TRICARE! You can get TRICARE for your child in two steps:

Register your newborn or adopted child in the Defense Enrollment Eligibility Reporting System (DEERS). You must enroll in DEERS for TRICARE coverage.

You don't need a Social Security number to register your child in DEERS. Once you have one, update DEERS with that number.
https://tricare.mil/Plans/Eligibility/DEERS

Choose a TRICARE health plan and enroll your child. Come to our TRICARE Office, Room 1C69 for assistance.

Don't forget to keep your family's information up-to-date in DEERS.