When you submit a request for authorization, Humana Military/ValueOptions will send you a notice that the care has been authorized. The Authorization Notice is usually sent to you via fax and includes several pieces of information that are important for claims processing and referral tracking purposes.

One recent addition you will notice is a tracking number included on your notice of authorization. The Authorization/Order Number is a 15-digit number, which includes the military treatment facility (MTF) location code, the date issued and the sequence number.

The purpose of this number is to help the MTF track the care that is provided in conjunction with the referral and match up consult reports and referrals under the same episode of care.

In addition, the authorization number will also appear on the authorization notice. The authorization number is an 11-digit number plus four zeros at the beginning. Once an authorization is approved, a notice of authorization is auto-faxed to those providers with fax machines and a copy is sent to the beneficiary.

The Notice of Authorization contains this information:
 

• Provider’s name, address and phone number
• Beneficiary’s name and address
• Sponsor’s Social Security number
• List of approved care including:
   
  
  • CPT codes
  • Descriptions
  • Number of units
  • Effective dates

Remember to note the authorization number for claims purposes. You are also encouraged to keep track of the number of units and the end date approved on the authorization.

If either the number of units has been exhausted or the end date has expired then a new request for authorization will need to be requested.

For behavioral health authorizations, submit an outpatient treatment report to ValueOptions at 1-866-811-4422.

  
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The HIPAA National Provider Identifier (NPI) compliance date—May 23, 2007—is fast approaching. By that date, all covered entities should have their NPIs and be prepared to submit their NPIs on HIPAA standard electronic transactions in accordance with the appropriate X12N implementation guide. TRICARE, like the majority of other payers, will not deny claims for failure to include the provider’s NPI on the HIPAA standard electronic transaction before the compliance date. However, in order to facilitate the use of the NPI as a routine practice for the submission of HIPAA transactions, providers are encouraged to begin using their NPI as their primary provider identifier as soon as possible. Providers may continue to provide their legacy identifier in support of their NPI until further notice.

Providers treating TRICARE beneficiaries as a result of referrals should also be aware that transactions will continue to be processed if the NPI for the referring provider is not included on the transaction. However, providers are encouraged to obtain the referring provider’s NPI and include it on transactions per the implementation guide for each transaction. The NPI should be provided, if appropriate, per the implementation guide for the transaction.

  
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Updated: April 7, 2008