How to Read HNFS’ Referral and Pre-Authorization Letters

Thursday, January 26, 2023

We understand you likely work with several different insurance carriers, each with their own unique way of doing business. To get the new year started off right, we would like to provide you with the following tips to help understand how to read our referral and pre-authorization letters for your TRICARE patients.

Health Net Federal Services, LLC (HNFS) faxes approval letters to the requesting and servicing providers and also posts them to our secure Authorization Status tool. HNFS processes routine requests within 2-5 business days. We will expedite our review of urgent requests (care needed within 72 hours) based on the clinical information submitted.

Here are some of the key items to look for in our approval letters:

Approved specialty provider. Keep in mind, care may have been referred to the local military hospital or clinic, even if your patient is enrolled there.
Patient details. This information includes name, phone number, plan type, date of birth, etc.
Reason for request. If the services were requested by a military facility, this section is where you’ll find the electronic signature statement, “This referral is electronically-signed by the ordering provider.” Please accept this statement as the signed order to prevent any delay in beneficiary care.
Service type, codes, dates, and visits/units. Some codes may show as a range.
Who requested the services. This could be a facility, group or an individual provider.
Fax number for returning consult reports. You will use this to return consult reports if the services were requested by a military hospital or clinic.

Didn’t get a letter? You can find copies of determination letters through our secure Authorization Status tool. Use our step-by-step guide, if needed. Your TRICARE patients can also log in to the Authorization Status tool to view and print letters for their own records.

For additional information on our referral and authorization process, visit our Authorizations page.