Referral and authorization requirements
TRICARE prior authorization and referral requirements vary according to beneficiary type, program option, diagnosis and type of care.
- Active Duty Service Members (ADSM): Should receive behavioral healthcare at a military hospital or clinic whenever possible and must have prior authorizations and/or referrals from their Primary Care Manager (PCM) and Humana Military before seeking non-emergency behavioral healthcare.
- Dual-eligible beneficiaries: Beneficiaries using Medicare as their primary payer may self-refer to any network or non-network behavioral health provider who accepts Medicare; referrals and/or prior authorization from Humana Military is not required. Beneficiaries should follow Medicare rules for services requiring authorization. When behavioral healthcare benefits are exhausted under Medicare, TRICARE becomes the primary payer, and prior authorization from Humana Military is then required.