Authorizations and Referrals
Providers can use our Prior Authorization, Referral and Benefit Tool to find out if an authorization or referral is required.
Providers are required to submit authorization and referral requests online. Learn more by visiting our How to Submit a Request for an Authorization or Referral page.
We recommend you register, as it is fast, simple and secure. Registration provides quick and easy access to tools such as authorization submission and status, claims submission, set up electronic funds transfer and view remits. If you choose not to register, you can still submit authorizations and referrals online using our Web Authorization/Referral Tool, which does not require an account.
HNFS processes routine requests within 2-5 business days and medically urgent requests in an expedited manner using the clinical information provided by the health care provider.
You can check the status of requests and view copies of determination letters online (log in to the Secure Portal), or use the automated self-service tools at 1-844-866-WEST (1-844-866-9378).
Our Online Submission Guide and video tutorial provide step-by-step instructions to help you submit your requests.
Submitting an authorization or referral request online through CareAffiliate is fast and secure, and allows you to submit your request and check the status of that request at your convenience. There will be times you will receive an immediate response to your request once submitted.
Some tips include:
- Use Google Chrome for best results.
- Clear your internet cookies regularly.
- The associated CPT code(s), number of visits and duration of the authorization will populate based on the request type selected.
- If you do not have a specific servicing provider in mind, enter the provider specialty and Health Net Federal Services will locate one for you.
- We offer a step-by-step guide to assist you, as well as live and recorded webinars.
HNFS will first attempt to coordinate requests for specialty care, inpatient admissions or procedures requiring approval for TRICARE Prime beneficiaries who live near a military hospital or clinic. Therefore, if the provider submits a prior authorization or referral request, the beneficiary may be referred to the military facility for care, regardless of whether a civilian network provider is requested. 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 more information.
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.
When submitting an authorization or referral request online through Care Affiliate®, you can add attachments and supporting documentation to your request. Our Online Submission Guide walks you through the process.
You can make changes to your processed prior authorization or referral online. Visit our Requesting Prior Authorization or Referral Changes page to learn more.
