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Submitting Referral and Authorization Requests Online (Article 8) |
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Submitting your requests for referrals or authorizations online is an effective and speedy method for processing your TRICARE referral and authorization requests. Web entry of referrals and authorizations includes some pre-populated information saving you time and eliminating paperwork. Follow these tips to ease the process:
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Complete the request accurately |
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You and your office staff can prevent problems and delays when entering a request by paying special attention to the required fields necessary to complete the referral or authorization for submission including the patient’s gender and diagnosis. It is important that any referral or authorization request include complete and accurate information to prevent delays in processing and generating a confirmation. View the online tutorial to learn more.
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Access the “Code Look-Up” feature |
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Our “code look-up” feature provides you with immediate explanation on whether or not a referral or authorization is needed, as well as determination on covered versus noncovered services. Procedure requests will also inform you if the service is expected to be performed at an Ambulatory Service Center (ASC) according to ASC grouper crosswalk.
The code look-up feature helps to decrease the number of unnecessary requests your office may submit. Humana Military will not generate an approval for non-covered services or for those that do not require a referral.
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Find a specific provider from the online provider listing |
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If you have a preferred network provider you wish to select for the referral or authorization, our online services offer a listing of area network providers for you to choose. We are happy to make the selection for you.
By following these simple tips when using the online referral and authorization process, you will get the referrals you really need, faster!!!
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Fax confirmations are generated for approved referrals and authorizations and will ensure the primary care manager and/or specialty provider are notified.
Beneficiaries will receive a letter with the approved referral or authorization, provider information and direction to call for an appointment.
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Correction to TRICARE Provider News, Special Bulletin Edition, 2005: Issue 1 (Article 9)
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In the article entitled, “Navigating HIPAA and PHI,” please see the revised answer below relating to the disclosure of health information to minors.
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If a patient is a minor or is not competent to make health care decisions, may I release information to the parent or guardian?
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Providers may release PHI to the parent or guardian without consent in most cases. Individual state law may prohibit the release of a minor’s information for health issues such as alcoholism, abortion, drug abuse, behavioral health, venereal disease or HIV. Please consult with your state law and see the FAQs available on the Health and Human Services Web site for more information.
For questions regarding health information privacy or the Privacy Rule please contact HHS at OCRPrivacy@hhs.gov.
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