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Referrals
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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 “ MyHMHS for Providers” feature, formerly the “Online Provider Services” 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.
- Submit a referral on the Web site, via fax, or over the phone.
- The quickest way to submit referral information is online via MyHMHS for Providers and the "Referrals and Authorizations” feature. Web site referral services have been automated, and in many cases provide immediate response and confirmation.
- You may also fax the Patient Referral Authorization Form (PRAF). The Humana Military PRAF fax number is 1-877-548-1547.
- For behavioral health referrals, contact ValueOptions at 1-800-700-8646.
- When completing the referral, always have the beneficiary sponsor’s Social Security number (SSN), diagnosis, and clinical data explaining the reason for the referral.
- Check referrals via MyHMHS 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, call 1-800-444-5445 or fax the PRAF to 1-877-548-1547.
The referral will clearly specify the services authorized, the number of visits, and the timeframe in which the visits must be completed.
- Humana Military will notify the beneficiaries of an approved referral.
Prior Authorization List for the South Region (Effective for 2011)
| 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 |
Concurrent reviews upon request by Humana Military |
| Bariatric surgery |
Discharge notification |
| Department of Defense (DoD) In-Utero Fetal Surgical repair of Myelomeningocele Clinical Trial |
Notification of acute care admission by the next working day |
| Educational interventions under the Enhanced Access to Autism Services Demonstration |
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| Extended Care Health Option (ECHO) services |
Behavioral Health |
| Home health services, including home infusion |
All nonemergency inpatient admissions for behavioral health care or substance use disorder |
| Hospice |
Partial hospitalization programs (psychiatric and substance use disorder) |
| Phase II and Phase III cancer clinical trials |
Psychoanalysis |
| Transplants (solid organ and stem cell, not corneal transplant) |
Residential treatment center programs |
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