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TRICARE beneficiaries are covered for a range of outpatient and inpatient behavioral health care services. These include:

• Individual psychotherapy
• Group or conjoint therapy
• Crisis intervention
• Collateral visits
• Family therapy
• Psychoanalysis
• Medication management
• Substance use rehabilitation stays
• Inpatient hospital care
• Acute inpatient care
• Inpatient psychotherapy

Beneficiaries may seek eight unmanaged outpatient visits in each fiscal year (Oct. 1–Sept. 30) without a referral or authorization. Certain outpatient services, however, such as psychoanalysis, crisis intervention, psychological testing and substance use treatment, require prior authorization.  Since there is no way for a provider to ensure that the beneficiary has not exceeded his or her limit of eight unmanaged outpatient visits per fiscal year, behavioral health providers are encouraged to call for prior authorization for all outpatient behavioral health services.

All inpatient behavioral health admissions require authorization. 

When a beneficiary has been referred for behavioral health care, TRICARE requires the rendering provider to fax a consult report to the PCM or referring provider within 10 working days of the initial visit. Emergency consult feedback is requested within 24 hours. Behavioral health care that has been self-referred does not require a consultation report.

For more information about behavioral health or substance use care, contact Humana Military’s behavioral health contractor, ValueOptions, at 1-800-700-8646.

Consult Reports Are Required within 10 Working Days  (Article 7)

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 routine specialty referrals for initial office visits, 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 returned to the initiating provider are important 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.