Provider Handbook - Behavioral Health-Referral and Authorization Requirements

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Behavioral Health Services Referrals & Authorizations Referral & Authorizations by Category Provider Responsibilities Outpatient Services Inpatient Services Partial Hospitalization Programs Residential Treatment Centers Substance Use Disorders Court Ordered Care Non-Covered Services Management Appeals & Reconsiderations Medical Record Documentation Billing and Claims Coverage Details

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Referral and Authorization Requirements

IIf a behavioral health care referral is necessary, contact ValueOptions at 1-800-700-8646. When you submit a request for authorization, Humana Military/ValueOptions will send you a notice that the care has been authorized. The authorization notice is usually faxed and includes important information for processing claims and tracking referrals.

For care referred by a military treatment facility (MTF), a tracking number will be included on your notice of authorization. The 15-digit Authorization/Order Number includes the MTF location code, the date issued, and the sequence number. This number helps the MTF track the care that is provided in conjunction with the referral and connects the consult reports and referrals under the same episode of care.

An authorization number—an 11-digit number with four leading zeroes—will also be included on the authorization notice. Once an authorization is approved, a notice of authorization is faxed to those providers with fax machines. A copy of the authorization is mailed to the beneficiary.

The notice of authorization contains:

Beneficiary’s name and address
List of approved care including:
- Current Procedural Terminology (CPT®) codes
- Descriptions
- Number of units
- Effective dates
Provider’s name, address, and phone number
Last four digits of the sponsor’s Social Security number

Remember to note the authorization number for claims purposes. You are also encouraged to keep track of the number of units and the end date approved on the authorization. Once the number of units has been exhausted or the end date has expired, a new authorization is required.

For behavioral health care authorizations, providers can fax a TRICARE Outpatient Treatment Report form to ValueOptions at 1-866-811-4422. Forms can be found online.

TRICARE beneficiaries, except active duty service members (ADSMs), may self-refer for the first eight outpatient psychotherapy visits to a civilian provider. Network providers are responsible for securing any necessary authorizations. If the provider fails to obtain the authorization, claims payment may be denied and the beneficiary is held harmless. Prior authorization requirements are listed in the following sections for each beneficiary category. In addition to these requirements, note that prior authorization is not required for emergency behavioral health care inpatient admissions when referred by an evaluating physician (M.D. or D.O.). However, admissions resulting from a bona fide psychiatric emergency should be reported to ValueOptions within 24 hours of the admission or the next business day.

Last Update: August 26, 2009