Prior Authorizations for Care

A prior authorization is a review of the requested health care service to determine if it is medically necessary at the requested level of care. Prior authorization is required for certain types of care and must be obtained before services are rendered.

Your PCM will request prior authorization from Humana Military when required. If the service is authorized, Humana Military will give your PCM an authorization number along with specific instructions. For example, prior authorizations for medical or surgical services will have a begin date and end date. Prior authorizations for behavioral health services will specify a number of visits as well as a begin date and end date. You must receive care under the authorization before it expires. If not, you will need to get another referral and authorization from your PCM.

Active duty service members require prior authorization for all inpatient and outpatient specialty services. An additional fitness-for-duty review is required for maternity care, physical therapy, mental/behavioral health services, family counseling, and smoking cessation programs.

For all other TRICARE Prime enrollees, the following services require prior authorization in all three TRICARE regions:

Visit Humana Military’s Prior Authorization list (updated April 1, 2009) or call 1-800-444-5445 to learn about their requirements, as they may change periodically.