Fort Hood TRICARE Behavioral Health Referral Process

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Fort Hood TRICAREBehavioral Health Referral
Process
20 July 2007
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Referral Sources
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Referral Sources
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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
• www.militaryonesource.com

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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)
• www.valueoptions.com

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Behavioral HealthcareNon-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

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Behavioral HealthcareActive 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 [phone])
• 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

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Behavioral HealthcareActive 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)

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Behavioral HealthcareActive 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)
• Soldiers 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.

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Behavioral HealthcareFormer 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
• Dont use any authorization numbers for your
  claims processing that were issued while patient
  was Active Duty they will be rejected
• You can call Referral Management Brach (RMB) to
  check patients current enrollment status or
  eligibility

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Behavioral HealthcareLPCs, 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

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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 patients PCM
• Its still a work in progress
• CRDAMC RMB tries to fax the initial referral to
  the authorized provider
• Narrative on the providers 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 (RR
  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.

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Fort Hood TRICAREBehavioral Health Referral
Process
20 July 2007