Obtaining Authorization
Only the primary care manager (PCM) can approve health care outside of the MTF. To do so, you must fax a referral to Humana Military at 1-877-548-1547. Humana Military will forward the referral to ValueOptions, the behavioral health care subcontractor for Humana Military in the TRICARE South region. Once ValueOptions has authorized the care, a copy of the authorization approval will be forwarded to the PCM, the ADSM and the behavioral health care provider. MTF PCMs will need to complete DD Form 2161 or SF513 (the electronic version of DD Form 2161) and fax it to Humana Military. If you do not have the DD Form 2161 or SF513 forms available, contact ValueOptions at 1-800-700-8646 to obtain copies for use in your office.

Behavioral health care network providers should not provide treatment to ADSMs without prior authorization for an ADSM because the services may not be reimbursed. Some ADSMs who are part of the TRICARE Prime Remote (TPR) program do not have PCMs. These ADSMs have been instructed to call ValueOptions at 1-800-700-8646 for behavioral health care authorizations.

Reporting Treatment
To ensure coordination of care, behavioral health care providers are required to complete a consult report after the initial visit and submit it to the PCM within 10 working days of the patient visit. If inpatient care is provided, the behavioral health care provider must send a discharge summary to the PCM. Consult reports and discharge summaries should also be faxed to Humana Military at 1-877-850-9599.

Communicating behavioral health care information to the PCM is important to ensure that service members are fit for duty and will not pose a risk to themselves or their units. Under Department of Defense (DoD) policy, ADSMs’ treatment information must be released to their PCMs.

Handling Psychiatric Emergencies
TRICARE defines an emergency as a medical or psychiatric care need that would lead a “prudent layperson” (someone with average knowledge of health and medicine) to believe that a serious medical condition existed, that the absence of medical attention and treatment would result in a threat to his or her life, limb or sight or that painful symptoms exist requiring immediate attention to relieve suffering. If you feel an ADSM is in an emergency situation, instruct them to call 911 or go directly to the nearest emergency room. ADSMs have been instructed that they (or someone acting on their behalf) should contact their PCM or regional contractor as soon as possible following treatment to report the emergency and to coordinate follow-up care.

For more information, call ValueOptions at 1-800-700-8646 or visit Provider Resources where you can find many behavioral health care forms.

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