MTF Right of First Refusal FAQs

Military Treatment Facilities have what is known as the “right of first refusal (ROFR).” Beneficiaries referred outside of an MTF for specialty care or other services requiring a referral must first be considered for care inside the MTF if the services are available.

 

The Right of First Refusal will only be used for beneficiaries meeting the appropriate access standards and where the MTF has indicated the desire to receive referral requests based on specialty, diagnosis code, procedure codes and/or enrollment categories.

 

Humana Military’s referral management team will send referral information to the MTF point of contact. The MTF will respond generally within one business day from the receipt of the request. When no response is received from the MTF within one business day, Humana Military will process the referral request as if the MTF declined to see the patient.

In the case of same day and 72-hour referrals, Humana Military will notify the MTF point of contact. If the MTF does not respond, the referral request will be processed as if the MTF declined to see the patient.

 

In this case, the MTF will advice Humana Military within one business day from the receipt of the referral. The MTF may contact the beneficiary to schedule an appointment.  Humana Military will also notify the beneficiary of the MTF’s acceptance and provide instructions for contacting the MTF to obtain an appointment.