Frequently Asked Questions
 

Military treatment facilities (MTFs) have the option to exercise what is known as the right of first refusal
(ROFR). Beneficiaries referred for care outside of an MTF for specialty care and/or other services requiring a referral or authorization must first be considered for care at the MTF if the services are available there.
 
Which Beneficiaries Qualify for ROFR?
ROFR applies to TRICARE Prime beneficiaries living in a TRICARE Prime Service Area (PSA) who meet 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. Information about TRICARE Prime and TRICARE PSAs can be found in your TRICARE Provider Handbook.
 
How Does the ROFR Process Work?
Humana Military’s referral management team will send referral/authorization information to the MTF point of contact (POC). The MTF POC will generally respond within one business day from receipt of the request. If 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.
 
What Happens When an MTF Exercises ROFR?
When an MTF elects to accept the patient for care (i.e.,exercises its ROFR), the MTF POC will advise Humana Military generally within one business day from receipt of the referral/authorization. Humana Military will then notify the beneficiary of the MTF’s acceptance and provide instructions for contacting the MTF to obtain an appointment.
 
How Can I Ensure the ROFR Process Will Work Well in My Office?
You can ensure this process runs smoothly by taking the following actions:

• Build/request referrals using the options available to your office online on our MyHMHS for Providers page or by faxing a referral/authorization request to the MTF using the Patient Referral Authorization Form.
• Understand that even if you select a provider for referral, the local MTF may review the referral and override your selection by exercising the ROFR.
• Make the beneficiary aware that the MTF ROFR may take precedence on the referral selection.