Reminder: Authorizations Required Beyond Eight Visits

Eligible TRICARE beneficiaries, including active duty family members (ADFMs), retirees and their family members, may self-refer to network providers (except pastoral counselors, licensed professional counselors and licensed mental health counselors) for the first eight behavioral health visits per fiscal
year (Oct. 1–Sept. 30) without prior authorization from ValueOptions, Inc. (ValueOptions), Humana Military’s behavioral health subcontractor. However, authorization is required prior to the ninth visit.
 
Active duty service members (ADSMs) may receive behavioral health care at a military treatment facility (MTF) without referral, but a referral and prior authorization are required before receiving any behavioral health services from a civilian network provider.
 
To avoid administrative delays or reductions in reimbursement, it is strongly recommended that providers verify whether or not the patient has expended his or her eight unmanaged visits. Additionally, providers are encouraged to contact ValueOptions to obtain an administrative authorization for claims payment purposes.
 
If authorization is not obtained prior to the ninth visit, providers may fax a retrospective Outpatient Treatment Report (Retro OTR) to 1-866-811-4422 and it will be reviewed for medical necessity. If the request meets criteria, the submitted claim will be paid; however, a penalty will be assessed due to failure to obtain prior authorization.
 
If you have questions about prior authorizations, call ValueOptions at 1-800-700-8646.