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Consult Reports Are Required within 10 Working Days (Article 4)

Consult reports are required to be returned to the primary care manager (PCM) or initiating provider within 10 working days of the patient encounter. For specialty referrals, all outpatient services and inpatient services, you must provide complete and legible documentation for these reports to be accurate and useful.

Consult reports, op reports and discharge summaries are important to the initiating provider for timely follow up and continuity of care. Please be responsive to the request when asked to return a consult report for TRICARE beneficiaries.

Providers who treat TRICARE beneficiaries coming from the local military treatment facility (MTF) may receive a faxed reminder to return a consult report for a recent visit/service.  Your office should return the consult report, op report or discharge summary requested and use the designated fax reminder as the cover sheet. Please use the fax number listed in the upper right corner of the reminder page. This fax number is shown only on the reminder fax to providers for each beneficiary consult return request. This is to avoid having providers send documentation on all other TRICARE beneficiaries.

AutoFax System Simplifies Referral and Authorization Process (Article 5)

When working with referrals and authorizations, primary care managers (PCMs), facilities and specialists should be aware of the AutoFax system for coordinating the referral and authorization process. This Humana Military system automatically generates a faxed copy of the approved referral and sends it to any provider involved in delivering the service, such as the PCM, the referred-to provider and the facility involved. The beneficiary gets a similar confirmation delivered to them both by U.S. mail and via an automated outbound telephone call.

Oftentimes, the AutoFax referral or authorization will be the only notification a provider will get that he or she is getting a referral. If the patient has not called to make an appointment, the provider should keep the confirmation on file. Remember, patients do not activate about 50 percent of requested referrals, meaning a provider could get a number of referral confirmations by AutoFax and never be involved in providing the requested service. But for those services in which patients do activate the referral, it will be necessary to have the AutoFax confirmation.

The AutoFax confirmation will include the patient’s demographic data and other information about the referral, such as the services authorized, the referring PCM and the Humana Military phone and fax numbers.

Providers are asked to: leave fax machines on after hours, including weekends, report any fax number changes to a provider relations representative and program your fax machine so that your fax number appears on any requests sent by fax.

Fax Confirmations for Obstetrics and Maternity
For obstetricians and facilities involved with labor and delivery, the AutoFax system provides a confirmation for all approved services. The obstetrician will need an authorization to provide prenatal, delivery and postpartum care, and the facility will need authorization for the patient’s labor and delivery.  Failure to have such a confirmation could result in the provider and the facility having to pay for the service.

Authorization is required for all maternity inpatient stays as well. The benefit for length of stay for the mother and child in the hospital will be for not less than 48 hours following a normal vaginal delivery and not less than 96 hours following a cesarean section without complications. Maternity care involves the medical services related to conception and delivery, such as prenatal and postpartum care and treatment of complications of pregnancy. Postpartum care generally is covered through the sixth week post-delivery.