Tips for making referrals and authorizations

Submitting a request online is the quickest and most convenient way to obtain a referral or authorization.

  • 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.
  • Up to five optimal provider choices will reflect 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, the services requested may be subject to redirection to the military hospital through the Right Of First Refusal (ROFR) process.
  • When completing the referral, always include the sponsor’s TRICARE ID, diagnosis and clinical data explaining the reason for the referral.
  • If the patient needs services beyond the referral’s scope, the PCM must approve additional services.
  • Check the status of the referral or authorization online or by phone at (800) 444-5445.
  • To expedite certain requests, outpatient substance abuse treatment programs and Applied Behavior Analysis (ABA).
  • Humana Military will notify the beneficiary and provider of an approved referral or authorization.

 

Tips for hospital admission notifications

Submitting the notification online is the quickest and most convenient way to notify Humana Military of a hospital admission. In many cases, the admission is immediately approved.

  • Entering a new hospital admission notification is easy. Log in to provider self-service, select new request for referral or authorization, including hospital admission and follow the simple steps to complete the request.
  • Submit continued stay reviews and notify Humana Military of a patient’s discharge online. It is important to notify Humana Military when a patient is discharged. This allows the authorization to be completed and the claim to be properly processed.

For behavioral healthcare admissions, submit notifications online. This is the quickest and most convenient way to notify Humana Military of a hospital admission. Facilities unable to submit online can fax the admission request to Humana Military at (877) 200-0401.