The first day of the new TRICARE fiscal year, Oct. 1, renews the behavioral health care outpatient visit count for all TRICARE beneficiaries except active duty service members. The first eight outpatient behavioral health care visits to network providers* per fiscal year do not require prior authorization
or a referral from the beneficiary’s primary care manager or Humana Military Healthcare Services, Inc. (Humana Military). Prior authorization from Humana Military’s behavioral health care partner, ValueOptions, is required for the ninth and subsequent visits for all beneficiaries. A physician referral is
not required for these visits, but authorization is required to establish medical necessity.
 
There are certain providers, however, for which a physician referral and supervision are always required, even for the first eight visits. These providers include licensed professional counselors, licensed mental health counselors and pastoral counselors.
 
Remember, active duty service members always need a referral from their primary care manager (or service point of contact if enrolled in TRICARE Prime Remote) and authorization from ValueOptions before obtaining civilian behavioral health care.
 
For more information visit our information on behavioral health care and prior authorization requirements.
 
* If a beneficiary chooses to self-refer to a nonnetwork provider, point of service fees will apply.