TRICARE BENEFICIARY POLICY
Office Policies For Referrals
1.You can do the following to check on your referral(s):
a. ) Call (800) 444-5445 or
b.) Log-in to the beneficiary self-service tab at www.humanamilitary.com to check on the status of your referral/s.
2. Humana military will allow up to 12 months for each approved referral. Please know the allowed # of visits.
3. Do not make an appointment without a valid authorization. We will NOT be able to facilitate same day referrals.
4. If you require additional visits other than what is authorized, your specialist office can request an extension or continuation of visit.
Tricare allows a specialist that you have an approved referral to see to also submit referrals for care related to their specialty. You will not need to request it from us.
(www.Humanamilitary.com website for further information about Referrals and Authorizations)
5. Ensure that the approved specialist sends us a report of their findings after every visit. As your PCM and referring provider, it is best that we have information on your treatment for your files.
We will also need your office visit notes to refer to for visit extensions or other long-term referral needs.
6. An appointment with us is necessary when:
a. ) It has been a year since the initiation of a referral, and it has expired.
b. ) We do not have any medical records from the specialist office stating continuation of care is required.
c. ) When the specialist office refuses to request a referral for you to extend, change and approve you for any procedures that they will do.
d. ) A referral is needed for a medical condition that has not been evaluated by your PCM.
e. ) It has been more than 6 months since your last appointment with your PCM.
WHAT WE CAN HELP WITH
WHAT WE CANnot HELP WITH
Send an authorization request to Tricare within 5 business days after your
appointment with us for any service we are unable to perform as your PCM (Primary Care Manager).
Facilitate your appointment with the approved specialist – we will send the medically necessary information to them once the referral has been approved.
Inform you of the outcome of the authorization.
If possible, make your appointment for you and let you know. You may also contact them directly to schedule.
Retroactively request a referral for you.
Mark your referral as URGENT unless deemed necessary by our treating provider. All your referrals will be marked routine.
Request a referral if your referral has EXPIRED.
Create additional referrals requested by the specialist office