Referrals

How do I get a referral?

The diagnosing provider will submit a referral to Humana Military for ABA services. Referrals must specify Applied Behavior Analysis (ABA) services and include proof of a definitive diagnosis using the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5 (or current edition)), including initial date of diagnosis, through either a referral reflecting a diagnosis of ASD or a diagnostic evaluation. DSM criteria must be documented in a DHA-approved checklist.

For beneficiaries enrolled to the ACD prior to Oct. 1, 2021, TRICARE-authorized ASD-referring and diagnosing providers have the option of submitting a definitive diagnosis referring provider attestation which fulfills both the DSM-5 diagnostic checklist and validated assessment tool eligibility requirements for the two year PCM referral requirements.

Your provider should submit referral requests online for faster processing. The referral for ABA form and supporting documentation may be faxed when needed to (877) 378-2316. Please be aware that failure to provide necessary clinical information may result in delays, terminations of authorized care and denials for pended claims.

Referral cycle

Referrals for ABA services are valid for two years. The referral due date will be provided in writing to help track when a new request will be required.

The two-year referral cycle starts with the initial verified referral for ABA. Prior to the end of the current two-year cycle, a new referral must be submitted by your TRICARE-authorized ASD-diagnosing or referring provider.

Referrals remain valid within the two-year timeline, even if you:

• Change providers
• Get a second opinion
• Move within the TRICARE East Region or outside of the TRICARE East Region