Look Up Approval Requirements for Ancillary Services with New Online Tool
Thursday, February 2, 2023
Should you need to order diagnostic services for your TRICARE patients, Health Net Federal Services, LLC (HNFS) wants to make sure you can quickly and easily determine whether pre-authorization is required. To simplify the process, we now offer an “Ancillary Services Requirements” online tool that allows you to verify whether you will need HNFS’ approval for an ancillary service or if a doctor’s order will be sufficient. From the provider portal at www.tricare-west.com, click on “Is Approval Needed” under "Authorizations" to get started. From there, click on the “Ancillary Services Approval Requirements” button.
Using the tool
You can search the tool by entering a specific billing code or description of the service. Codes/services will auto-populate once you start typing.
After making your selection, you’ll see a result of either:
- YES: This means you need to submit a request to HNFS for approval. Access CareAffiliate® to submit your request.
- NO: This means your patient only needs a doctor’s order (such as a lab slip) for the service. Please consider codes with “NO” responses to be covered under “evaluate only” or “evaluate and treat” referrals as part of approved episodes of care.
- NO; however, this service has benefit limitations: This means you don’t need HNFS’ approval (only a doctor’s order is required), but you should review benefit limitations in the TRICARE Policy Manual and on our “Benefits A-Z” web pages.
- Not a TRICARE-covered benefit: This means the service is not covered under the TRICARE benefit.
Choose the “Download PDF” to print the results. Keep in mind, most diagnostic services, such as laboratory and radiology tests (excluding laboratory developed tests), and services administered in the provider's office – such as echocardiograms, Holter monitors, and routine treadmill tests – do not require approval from HNFS. (Tip: If an ancillary service was referred by a military hospital or clinic and approved by HNFS, HNFS’ approval letter will serve as the doctor’s signed order.)
We appreciate your cooperation with these guidelines.
