Save Time: Submit Referrals and Authorizations Only When Required

Wednesday, March 3, 2021

As our referral and authorization volumes return to pre-pandemic levels, we want to remind you of simple guidelines to follow for your TRICARE patients. Knowing when, and when not, to submit authorization or referral requests to Health Net Federal Services, LLC (HNFS) saves you time and expedites access to care for your patients. 

Did you know not all covered TRICARE services require a referral or authorization? In fact, most diagnostic laboratory tests and radiology services do not require HNFS approval. Avoid extra work by only submitting requests to HNFS if they are needed. Familiarizing yourself with the requirements is an important step in helping your TRICARE patients get the care they need without delay.

Before you submit: 

1. Have you checked requirements? Use our Prior Authorization, Referral and Benefit tool to determine if a referral or authorization is needed. Remember, TRICARE Select patients do not require a referral for specialty care (except for applied behavior analysis, or ABA, services). And non-active duty service members who have other health insurance only require prior authorization for ABA services.
   
   
2. Is it a limited benefit? HNFS offers Letters of Attestation (LOAs) for several limited benefits. You can attach the LOA instead of clinical documentation to your online request, which will expedite the review process. 
   
   
3. Is it an ancillary service, such as diagnostic radiology or lab tests? Our TRICARE Ancillary Services list tells you if you need an approval from HNFS. Most ancillary services do not require an approval. 
   
   
4. Do you need to change an existing authorization? If you need to request changes, please do not contact the referring provider or military hospital or clinic. Many changes can be requested through our online Outpatient Authorization Change Request Form. If your patient needs care beyond the expiration date or additional services that need HNFS approval, submit a separate, new request.

Find additional authorization and referral details on our Authorizations page.