Things You Should Know This Week 6/1/2026
TRICARE Recoupments and Clawback Activity
Practices across the country continue reporting payment adjustments and recoupment notices related to the transition to the new T-5 Tricare contracts.
In many cases, the new T-5 agreements included reimbursement reductions of nearly 20% buried within the contract language. However, TRICARE contractors initially continued paying claims at the previous contracted rates following implementation.
We are now seeing contractors go back retroactively and recoup those overpayments, requesting providers repay the difference between the old rates and the newly contracted T-5 rates.
LRS was successful in negotiating improved reimbursement rates for our clients during the initial T-5 rollout and we are continuing to see negotiations remain successful even now. Providers should not assume the initially proposed rates are final or non-negotiable.
UnitedHealthcare / Optum Updates
UnitedHealthcare recently announced plans to reduce prior authorization requirements on certain services by the end of 2026. While we are hopeful this may improve administrative burden long term, we continue to see significant operational and claim processing issues impacting PT, OT, and SLP practices nationwide.
At the same time, providers are continuing to experience:
Claims processing under incorrect fee schedules
Incorrect out-of-network processing
Providers loaded incorrectly despite active credentialing
Payments tied to the wrong provider profile or TIN
Delays resolving claim investigations
Reimbursement discrepancies related to Box 33 processing issues
In many cases, practices are being told credentialing and contracting are correct while claims continue processing inaccurately on the backend.
Action Item:
We strongly recommend reviewing reimbursement trends closely and auditing claims regularly rather than assuming payment reductions or processing outcomes are accurate. Even small discrepancies can create significant revenue impact over time.
Payer Loading & Enrollment Delays
We continue to see widespread payer loading and enrollment issues across multiple commercial and Medicare Advantage plans.
We are seeing these issues firsthand across several major payers including:
UHC / Optum
Humana Medicare
Anthem BCBS
CareSource Medicaid
HealthSpring
Aetna
TRICARE