Fort Hood TRICARE Behavioral Health Referral Process

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Fort Hood TRICARE Behavioral Health Referral Process

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1. Fort Hood TRICARE Behavioral Health Referral Process

2. Referral Sources

3. Referral Sources

4. Referral Sources Military One Source (MOS) Not the same as TRICARE Claims sent to TRICARE will be denied Not all MOS providers are credentialed with TRICARE (Value Options) For non-medical counseling Patients, including Active Duty soldiers, may self-refer for up to 6 visits If seeing an MOS provider not associated with Value Options, patient may be directed to further care with VO

5. Referral Sources TRICARE (Value Options) Not the same as Military One Source (MOS) For medical/non-medical counseling TRICARE behavioral health subcontractor to Humana Military Healthcare Services (HMHS)

6. Behavioral Healthcare Non-Active Duty Non-AD Patients may self-refer for up to 8 visits Non-AD also include retirees and their dependents After 8th visit, another authorization from PCM / MTF required Call CRDAMC Referral Management Branch for authorization status 254-553-1836, 1837, or 1835

7. Behavioral Healthcare Active Duty Active Duty MAY NOT self-refer under TRICARE Require PCM referral and MTF authorization Claims for AD soldiers without a referral will be denied. Need a separate authorization for each provider (psychiatrist, psychologist, social worker, etc.) even if you share the same office Up to 8 visits per authorization After 8th visit, CRDAMC will need documentation of past care and anticipated treatment care plan Send plan to CRDAMC RMB (fax 254-553-1819) Another 8 visits may be authorized After 16th visit, soldier must see PCM for another referral for continued care General rule = 16 visits in 6 months per provider

8. Behavioral Healthcare Active Duty For continuity of care issues or if the soldier has requested a particular provider RMB will attempt to place patient IAW patient desires If provider named in authorization has a long waiting list You can change authorization to another provider in the same office with earlier appointments Call one of the nurses at the Referral Management Branch (RMB) to assist with the provider changed (553-1879 / 1878)

9. Behavioral Healthcare Active Duty If you believe a soldier would benefit from a medication evaluation, make arrangements with a network psychiatrist based on urgency or appointment availability Fax a report to CRDAMC RMB (254-553-1819) Soldierís name and SSN Name of Psychiatrist Date of appointment Diagnosis RMB will enter the referral for this action and process the authorization. AD soldiers can always be seen in an EMERGENCY without a prior authorization.

10. Behavioral Healthcare Former Soldiers Former soldiers = retired & separated Retired (including medically retired) addressed in earlier slide Newly separated = no longer on Active Duty May be on Transitional Assistance Management Program (TAMP) (up to 180 days post separation date) They do not need a PCM referral (even if they were seeing you previously) Usually will be enrolled to a civilian PCM If not enrolled in Prime, then TRICARE Standard deductibles and cost shares apply May have no further medical benefits or entitlements after discharge Donít use any authorization numbers for your claims processing that were issued while patient was Active Duty Ė they will be rejected You can call Referral Management Brach (RMB) to check patientís current enrollment status or eligibility

11. Behavioral Healthcare LPCs, MHCs, PCs LPCs, MHCs, and PCs must have physician oversight TRICARE requirement that cannot be waived CRDAMC PCMs will not sign the Letter of Referral CRDAMC PCMs will not provide oversight responsibilities Must use a civilian provider for this Value Options will assist you in finding a physician for this purpose

12. Behavioral Healthcare CRDAMC requested that the clinic phone number of the ordering provider be placed on the authorization For providers wanting a telephone conference with the patientís PCM Itís still a work in progress CRDAMC RMB tries to fax the initial referral to the authorized provider Narrative on the providerís authorization does not contain all of the clinical information Call RMB if you do not receive a copy of the initial referral Fort Hood Resilience and Restoration Center (R&R Center) Located behind CRDAMC in building 36003 Soldiers can call for an appointment or to reach someone in the center 254-553-2284 or 254-553-2285.

15. Fort Hood TRICARE Behavioral Health Referral Process

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