TRICARE East Region: Beneficiary Referral andAuthorization Frequently Asked Questions (FAQ)
How can I view my referral/authorization and check status?
Visit beneficiary self-service or mobile app to view referral/
authorizations.
(Tutorial: Registering for self-service / Tutorial: Check yourreferral status).

How long does it take a referral/authorization to appear
in self-service?
Following receipt, allow up to three business days for a referral,and up to five business days for an authorization.

Who should I contact if my referral/authorization isnot showing?
Contact the referring provider to confirm request has been submitted.

What if I need to be seen today (urgent care center)?
TRICARE Prime non-active duty do not require a referral toseek care at any TRICARE-authorized network or non-network
urgent care center.

What is the difference between a referral andprior authorization?
Referral – is when your PCM sends you to another provider forcare. If you have TRICARE Prime and see a provider other thanyour PCM for nonemergency care without a referral, you will pay
more. Certain benefits, such as the Autism Care Demonstration(ACD), require a referral and continued authorizations.
Prior authorization – is a review of a requested healthcare
service done by Humana Military to see if the care will becovered by TRICARE. Check for services that need preauthorization at TRICARE.mil.

Why was I sent to the military hospital or clinic for care?
If the beneficiary resides within a military hospital’s catchment area
(40-mile radius), the services requested may be subject to redirection
through the TRICARE Right of First Refusal (ROFR) process.

How do I file an appeal?

How do I get a referral?

Appeals must be filed with Humana Military within particulardeadlines. Prior authorization denial appeals may be either
expedited or non-expedited, depending on the urgency of thesituation. Find more at File an appeal.

TRICARE Prime enrollees will need to contact their assigned
Primary Care Manager (PCM) for a referral to avoid point ofservice charges.

Are prior authorizations or referrals required if I have
Other Health Insurance (OHI)?

TRICARE Select and Continued Health Care Benefit Program(CHCBP) enrollees do not require a referral. However,authorizations may be required for services outside of aphysician’s office.

How do I find out if I need a referral?
Whether or not you need a referral depends on who you are andwhat TRICARE plan you are enrolled in.
See detailed information at Do I need a referral?

No. TRICARE is the secondary payer to all health benefits andinsurance plans, except for Medicaid, TRICARE supplements,
the Indian Health Service and other programs or plans as
identified by the Defense Health Agency (DHA). (Additional
OHI exceptions can be viewed at TRICARE and Other Health
Insurance (OHI)).

How can I update my referral or prior authorization?
Visit HumanaMilitary.com/beneficiary to use our quick and easychat and secure messaging features to request a change or update.

Humana Military is the administrator of the Department of Defense (DoD) TRICARE East program.
TRICARE is a registered trademark of the DoD, Defense Health Agency (DHA), all rights reserved.

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TRICARE East Region: Beneficiary Referral andAuthorization Frequently Asked Questions (FAQ)
Do I need a referral to see a mental health therapist?
(Non-emergency mental healthcare)No. A prior authorization is required for psychoanalysis andSubstance Use Disorder (SUD) care.
If you choose a provider outside the network, you may payhigher costs.
Note: If you are an Active Duty Service Member (ADSM)
seeking care in the TRICARE network, you must get a referraland pre-authorization. (Additional information available:(Getting Mental Health Care)).

What is the difference between a TRICARE-authorized /network / non-network providers?
TRICARE-authorized provider is approved by TRICARE togive healthcare services to beneficiaries. A provider must beTRICARE-authorized for TRICARE to pay any part ofyour claim.
Network provider has agreed to accept the contracted rate as
payment in full for covered healthcare services and files claimsfor you.
Non-network provider doesn’t have an agreement with
TRICARE and may not file claims for you. There are two types of
non-network providers: participating and nonparticipating.
(Additional information available: TRICARE Choices in theUnited States).

What is the referral/authorization process for Applied
Behavior Analysis (ABA)/ACD services?
See Autism Center of Excellence.

Humana Military is the administrator of the Department of Defense (DoD) TRICARE East program.
TRICARE is a registered trademark of the DoD, Defense Health Agency (DHA), all rights reserved.

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