Guidelines for ECHO Authorizations
Per TRICARE policy, durable equipment (DE) must be essential to reducing functional loss resulting from a qualifying condition.
- The first step in requesting approval for DE under ECHO is for the physician primary care manager (P-PCM) to submit a referral to HNFS requesting approval for the DE. The request must specify:
- What the ECHO qualifying condition is as related to the request,
- Why the DE item is necessary and
- How the DE item is essential to reducing functional loss.
If additional information is needed, HNFS may request a letter of medical necessity from the P-PCM.
- The second step is for HNFS to obtain a cost quote from the DE supplier.
- Once HNFS has the P-PCM referral and the cost quote from the DE supplier, it can complete its review and make a determination.
Incontinence Supplies (Diapers)
- The beneficiary must be over the age of 3 years old.
- A referral is not required from the P-PCM (as it is with DE), but confirmation the beneficiary is incontinent as a result of spinal, neurological and/or mobility issues is required. This confirmation can be provided verbally or in writing when requesting authorization.
- HNFS contracts with durable medical equipment (DME) suppliers who can arrange for diapers or pull-ups in child and adult sizes.
- To initiate an authorization for incontinence supplies:
- The beneficiary can contact HNFS directly at 1-844-52-HELPU (1-844-524-3578). He or she must verbally attest to meeting the eligibility requirements for incontinence supplies and provide details to HNFS for the quantity, type and size of diapers needed.
- For ongoing supplies, the DME provider can submit an online authorization request for continued authorization.
- HNFS' standard is to approve 300 diapers per month; however, the beneficiary can request an amount individualized to the patient's needs.
- HNFS authorizes incontinence supplies for one year in duration.
- Beneficiaries may choose to purchase diapers and submit the claims or request a DME company ship the incontinence supplies to their residence.
ECHO Respite (up to 16 hours per month)
- A referral from the P-PCM is required annually and services are authorized for six months in duration.
- To initiate a review for ECHO respite, the P-PCM can submit an online referral request to HNFS. HNFS will confirm there is another concurrent ECHO benefit on file prior to approval.
- The ECHO respite benefit is only available for the ECHO-registered beneficiary and may not be used for siblings.