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A Simple Way to Attest to Clinical Criteria for Limited Benefits

Tuesday, March 3, 2020

Certain TRICARE benefits are limited and subject to specific clinical criteria. Common examples include radiofrequency ablation, laboratory developed tests, CT angiography of the heart, and breast MRIs (list is not all inclusive). When Health Net Federal Services, LLC (HNFS) receives an authorization request for a limited-benefit service, we must first verify the patient meets the clinical requirements as determined by TRICARE policy. To expedite this process, HNFS offers a suite of letters of attestation (LOAs) providers can complete and submit with their initial authorization request. Use these LOAs in place of submitting separate clinical documentation. 

Did you know? CareAffilliate®, HNFS’ preferred online authorization submission tool, allows for attachments. We encourage providers to use CareAffiliate to attach LOAs with limited-benefit requests, so we can begin our clinical review upon receipt. You must be registered at www.tricare-west.com to use CareAffiliate, so if you haven’t already, be sure to start the registration process today.  

If you submit limited-benefit authorization requests using HNFS’ other online authorization tool, the Web Authorization Referral Form (WARF), the request will automatically pend as WARF does not allow for attachments. HNFS will contact you with instructions on how to return an LOA or supporting documentation so we may complete the clinical review. 

LOAs are not available for all services; however, as additional limited benefits are identified for which a LOA is appropriate, HNFS will add them to the list.

Visit our Letters of Attestation page for all available LOAs. Be sure to use the most recent copy when submitting a request, as the requirements and benefits can change.