The new fiscal year began October 1, which means TRICARE beneficiaries’ eight unmanaged psychotherapy visits renewed. It is important to know when these benefits renew so you can plan to continue care accordingly for your TRICARE patients.

The eight unmanaged visits allow TRICARE beneficiaries, except active duty service members (ADSMs), to self-refer to a TRICARE network provider for behavioral health care. When a beneficiary self-refers for care, it is recommended that you verify with ValueOptions that the beneficiary is within the first eight visits and has not used the sessions with another provider.

Each provider will be allowed one outpatient psychiatric diagnostic interview session (90801) per beneficiary per year without authorization; however, if you are a Licensed Mental Health Counselor (LMHC), a Licensed Professional Counselor (LPC) or a Pastoral Counselor, a letter of referral will be required. If a provider needs more than one 90801 session within the same benefit period, authorization must be requested using the “Outpatient Treatment Request (OTR)” form.

Keep in mind that any psychotherapy sessions beyond the eight unmanaged visits will require prior authorization from ValueOptions. You are responsible for obtaining prior authorization on behalf of your patients for all care beyond the unmanaged eight visits. Failure to obtain authorization could result in claims being denied and the beneficiary would be held harmless.

To request continued outpatient care, complete the OTR form. Fax the completed form to ValueOptions at 1-866-811-4422.

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A Few Reminders about Consult Returns (Article 8)

Returning consult reports in a timely manner is very important to providing the best quality health care possible to TRICARE beneficiaries. This is especially true for those assigned to local military treatment facilities (MTFs) who are referred out to our network provider community for evaluation and treatment.

To help providers meet this requirement and expedite the consult return process, autofax confirmations are issued at the time a referral/authorization has been established. The autofax confirmation includes the referral/authorization number and the consult return fax number when applicable.

• If you are using a transcription service for your medical reports and you rely on them to return consults to Humana Military, be sure that they have the appropriate consult return fax number that is identified on the referral confirmation fax sheet for the patient.
• Consult reports should be returned within 10 days following the patient’s appointment.
• For urgent consults that need to get back to the primary care manager (PCM) within 24 hours, contact the PCM by phone and follow up by sending the formal consult report to Humana Military within the next 10 days.
• For reports to be accurate and useful, please submit complete and legible documentation.

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