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How do I determine a patient's eligibility for TRICARE?
TRICARE is available to eligible beneficiaries from any of the seven United States uniformed services: Army, Navy,
Air Force, Marine Corps, Coast Guard, Public Health Services and the National Oceanic and Atmospheric
Administration. Enrollment in the Defense Enrollment and Eligibility Reporting System (DEERS) is the key to
maintaining beneficiary eligibility. However, providers cannot verify a beneficiary’s DEERS status directly because of
the Privacy Act. Providers can instead confirm that a patient has a valid uniformed services (military) identification (ID)
card (or authorization letter of eligibility) by checking the expiration date.
How can I make the referral and authorization process smoother?
When a TRICARE Prime beneficiary’s primary care manager (PCM) is unable to provide a specialized medical service,
the PCM must request a referral from Humana Military Healthcare Services. The Online Provider Services section of
Humana Military's Web site offers online referrals/authorizations, verification of existing referrals/authorizations, related referral/authorization functions, and diagnosis/procedure codes.
The quickest way to submit referral information is online via the "Online Provider Services" section. In many cases, it can
provide immediate response and confirmation. The next quickest way is to fax the Patient Referral Authorization Form to
Humana Military at 1-877-548-1547.
Providers are required to obtain authorization before performing procedures/services on the Humana Military prior
authorization list, which applies to both TRICARE Prime and Standard beneficiaries. This list is available online and from
TRICARE field representatives.
For more information, consult your TRICARE Provider Handbook or call toll-free 1-800-444 -5445.
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