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When a TRICARE Prime beneficiary’s primary care manager (PCM) is unable to provide a specialized medical service, the PCM must contact Humana Military to request a referral. Humana Military issues a referral when a TRICARE Prime beneficiary needs specialized medical services from a civilian professional or ancillary provider only if services are not available at the military treatment facility (MTF) or at the PCM’s office. The MTF is always the primary source of care for TRICARE beneficiaries. The MTF has the “right of first refusal” to provide care for a TRICARE beneficiary.

Referral requests may be submitted online via the “Self-Service for Providers” feature, formerly the “MyHMHS for Providers” link.  This is the fastest, most efficient way to get the information you need and keep the process moving.

Tips for Making Referrals

  • All referrals must be made to network providers where available. 
  • Submit all referral/authorization requests on the Web site, via fax, or over the phone-(for behavioral health).
  • The quickest way to submit referral information is online via Self-Service for Providers and the "Referrals and Authorizations” feature. Web site referral services are fully automated, and in many cases provide immediate response and confirmation. Urgent referrals can be done here as well.
  • Or, you may also fax the Patient Referral Authorization Form (PRAF). The Humana Military PRAF fax number is 1-877-548-1547.
  • Most behavioral health referrals can be done online, otherwise, contact ValueOptions at 1-800-700-8646.
  • Online requests prefill with minimal input on beneficiary data. Always have the beneficiary sponsor’s Social Security number (SSN), diagnosis, and clinical data explaining the reason for the referral.
  • Check referrals via Self-Service for Providers. To check the referral status by phone, call Humana Military’s TRICARE Service Line at 1-800-444-5445 and select the option, “To check the status of an authorization or previously requested service.”
  • For urgent referrals, you may choose to do online or you may call 1-800-444-5445 or fax the PRAF to 1-877-548-1547.
  • The confirmation posted and/or faxed to your office will clearly specify the services authorized, the number of visits, and the timeframe in which the visits must be completed.
  • Humana Military notifies the beneficiaries of an approved referral.

Prior Authorization List for the South Region

Procedures and Services Inpatient Hospital Stays
Adjunctive dental Admissions or transfers to skilled nursing facility, rehabilitation, long-term acute care
Advanced life support air ambulance in conjunction with stem cell transplantation Discharge notifications
Bariatric surgery Notification of acute care admission by the next working day
Educational interventions under the Enhanced Access to Autism Services Demonstration Behavioral Health
Extended Care Health Option (ECHO) services All nonemergency inpatient admissions for behavioral health care or substance use disorder
Home health services, including home infusion Partial hospitalization programs (psychiatric and substance use disorder)
Hospice Psychoanalysis
  Residential treatment center programs
Transplants (solid organ and stem cell, not corneal transplant) Outpatient behavioral health visits exceeding the initial eight visits each fiscal year (October 1 to September 30)

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Last Update: April 3, 2014