Authorization process for Tricare standard, extra and list of services

Beneficiaries Using TRICARE Standard and TRICARE Extra, TRICARE Reserve Select, or TRICARE Retired Reserve

Beneficiaries using TRICARE Standard and TRICARE Extra, TRS, or TRICARE Retired Reserve (TRR) generally do not need referrals and can receive their first eight outpatient visits without prior authorization to diagnose and/ or treat behavioral health components of an otherwise diagnosed medical or psychological condition. Services provided by a licensed or certified mental health counselor or pastoral counselor require physician referral and supervision.


Upon the first visit, providers may check eligibility, if registered, at www.triwest.com/provider or call 1-888-TRIWEST (1-888-874-9378) for eligibility verification or other questions. It is important to note that the first eight visits are per beneficiary, not per provider. Ask the beneficiary
if he or she has received previous behavioral health care.

After the first eight self-referred outpatient visits, prior authorization is required. Servicing providers must submit authorization requests online at www.triwest.com/provider, after registering, or complete and fax a Preauthorization for Outpatient Treatment Request form to 1-866-269-5892. The request will be reviewed to determine whether continuing care meets
InterQual criteria. No additional sessions are authorized until the treatment request is reviewed.

Additionally, the following behavioral health care services require prior authorization:
•     Crisis intervention Outpatient Services
•     ECHO
•     ECT
•     New and evolving technology
•     Nonemergency inpatient admissions for substance use disorder or behavioral health care services
•     PHPs
•     Psychoanalysis
•     Psychological/neuropsychological testing
•     RTC programs

TRICARE Standard, TRS, and TRR beneficiaries are encouraged to obtain care from TRICARE network providers, which reduces their out-of-
pocket expenses.


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