Outpatient TRICARE Service Request/Notification Form

When requesting a prior authorization or referral for outpatient health care services, providers should complete the Outpatient TRICARE Service Request/Notification Form and then print and fax the form to Health Net Federal Services, LLC at 1-888-299-4181.

  • Created: Jan 31, 2014
  • Modified: Jan 31, 2014
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