| |
|
|
Prior Authorizations Required for Certain Services (Article 5) |
|
A prior authorization is a process of reviewing certain medical, surgical and behavioral health services to ensure medical necessity and appropriateness of care prior to services being rendered.
|
|
If your patient needs a service or procedure that requires prior authorization, the request must be submitted to Humana Military prior to services being rendered. Inpatient or specialty care services require prior authorization from Humana Military and the service point of contact (SPOC). When prior authorizations for medical and surgical services are approved they will have a begin date and an end date. Authorizations are valid only for care that begins within 30 days of receiving authorization. Prior authorizations approved for behavioral health services are valid for the number of visits specified and will have a beginning and an end date. Network and non-network providers must obtain prior authorization for all required services, as defined by
Humana Military. Network provider claims submitted for services rendered without obtaining a required authorization are subject to a 10 percent penalty of the negotiated rate. In addition, some services may be excluded or have limited coverage
under TRICARE.
|
|
Prior authorization requirements may change, so providers should refer to the HMHS Referrals and Authorization System at Simply log on and click “Online Provider Services.” In this section you can: |
|
-
Enter a new referral/authorization.
-
Enter a new hospital admission notification.
-
Check the status of an existing referral/authorization request.
-
Check to see how a diagnosis code (ICD-9) is classified by TRICARE or look for a specific code using the appropriate CPT-4 code.
|
|
To view a complete prior authorization listing in the South Region, visit TRICARE.
|
|
Requests for authorization may be submitted in one of three ways: |
|
- Submit your request online at www.humana-military.com.
- Fax a completed Patient Referral Authorization Form to Humana Military at 1-877-548-1547.
- Call Humana Military at 1-800-444-5445.
|
|
Note: At this time, behavioral health providers are not able to use the referral/authorization portion of this online tool.
|
|
Back to Top
|
|
|
|
Contacts (Article 6) |
|
|
| |
Back to Top
|
|
Created: September 6, 2007
|
| |
|
| |
|
