Prior Authorizations and Referrals
Learn more about the differences on our Prior Authorizations and Referrals page.
TRICARE requires a provider, typically your primary care manager or family doctor, to submit prior authorization and referral requests. Please contact your provider and have him or her submit your request.
If you are a TRICARE Prime beneficiary living near a military hospital or clinic and are referred for specialty care, inpatient admissions or procedures requiring approval, HNFS will first attempt to coordinate your care at the military hospital or clinic. If the services are not available at the military hospital or clinic, the care will be coordinated with a TRICARE network provider.
Visit our Referrals to Military Hospitals and Clinics page for additional information.
It's important to prepare for your next doctor's appointment so you can get the most out of your time with him or her. We have created some appointment tips which include a checklist of the things you might want to ask your doctor and the things that are important for him or her to know.
Any denied authorization can be appealed. However, the following cannot be appealed:
- Authorizations approved under point of service.
- Authorizations redirected and approved to a network provider when a non-network provider was requested.
- Authorizations redirected and approved to a military treatment facility.
Learn how to file an appeal on our Authorization Appeals page.
Active duty service members who have other health insurance (OHI) require an approval from Health Net Federal Services for all services. All other beneficiaries with OHI only require a prior authorization for applied behavior analysis services. Beneficiaries with OHI need to follow their OHI rules for obtaining care even if those services are not covered by OHI or benefits have been exhausted.
Visit our How TRICARE Works with OHI page to learn more.
An approval from Health Net Federal Services, LLC is not required for breast pumps or supplies, as long as the breast pump obtained matches the type of pump included on your prescription from a TRICARE network or non-network physician, physician assistant, nurse practitioner, or nurse midwife.
Using a network provider will prevent you from having to pay for services up front and filing claims for reimbursement later.
View TRICARE’s Breast Pump and Supplies benefit page for more information on what’s covered.
Supplemental Health Care Option (SHCP) is a program for eligible uniformed service members who require medical care that is not available at the military hospital or clinic and must be referred to a civilian provider. The SHCP is also available on a limited basis for non-TRICARE eligible individuals when specifically referred by the military hospital or clinic.
Learn more by visiting our SHCP page.
Use the Check Authorization Status tool to change the provider to another network provider of the same specialty (some exceptions apply). For additional changes, your provider can send us a request online.
TRICARE requires beneficiaries access referral and authorization determination letters online. To do this, log in and click on “Secure Inbox.” If you do not have access to a computer, you can call customer service to request letters be mailed to you on a per-instance basis. You must do this each time you want a letter mailed, as beneficiaries cannot opt out from receiving electronic referral and authorization notifications.
