If a necessary service is not available from either the military hospital or clinic or the beneficiary’s Primary Care Manager (PCM), a referral is required. Some procedures and services, including hospitalization and ABA services, require prior authorization from Humana Military.
Create a new referral or authorization
The quickest, easiest way to request a new referral or authorization or update an existing referral or authorization is through provider self-service.
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*Providers should submit referrals and authorizations (including behavioral health) through self-service. Humana Military accepts faxed forms only if the provider is unable to submit them electronically.
- If the patient needs services beyond the referral’s evaluation and treatment scope, the PCM must approve additional services.
- All network PCM and specialist-to-specialist referral requests will be directed to system-selected providers or to providers the beneficiary has seen in the preceding six months.
- The choice of up to five providers will reflect the optimal options in terms of quality of care, accessibility (e.g., appointment availability), affordability and drive time from the beneficiary’s address.
- If the beneficiary resides within a military hospital’s catchment area (40-mile radius), the services requested may be subject to redirection to that military hospital through the Right of First Refusal (ROFR) process.
Tips for creating referrals and authorizations
- When completing the referral, always include the sponsor’s TRICARE ID, diagnosis and clinical data explaining the reason for the referral.
- View a tutorial for a step-by-step process of entering a new request and/or check/update an existing referral or authorization. Download tutorial
FAST Track is now available
Humana Military has developed an enhanced process for submitting referrals and authorizations through self-service. This new FAST Track process allows providers to submit requests quickly and more efficiently.
Updating an existing referral or authorization
Providers can easily update an existing referral or authorization through self-service.
Update existing referral/authorization