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Outpatient Referrals and Authorizations Extended 180 Days

Friday, May 29, 2020

With provider offices across the country rescheduling patient appointments due to the COVID-19 outbreak, we recognize some already-approved authorizations for your TRICARE patients may expire before pandemic restrictions are lifted. In an effort to support patient access to care and reduce administrative burden for your staff, we will be automatically extending certain outpatient referrals and authorizations an additional 180 days. No action is required on your part. We are updating our systems to reflect the new authorization end dates. HNFS is not issuing new approval notices; however, you can find revised approval details in our Authorization Status tool beginning early June. We encourage you to share this information with your TRICARE patients.

Key points

  • HNFS will extend already-approved outpatient physical health referrals and authorizations that expire(d) between March 1, 2020 and June 30, 2020. Please note exceptions below.
  • Extensions will be for a duration of 180 days from the original expiration date.
  • Extensions apply to active duty and non-active duty beneficiaries.

Thank you for your continued partnership in caring for military service members, retirees and their families.

Note: TRICARE eligibility guidelines still apply. Additionally, certain TRICARE benefits are only available to specific beneficiary categories (for example, dependents of active duty sponsors). As your patients’ enrollment status may change during the pandemic shutdown, it’s important to verify eligibility and benefit coverage prior to rendering services. Any authorization extensions issued do not supersede TRICARE‘s eligibility policies.

Extension Exclusions

The following outpatient care types are excluded from the 180-day extension:

  • Active Duty SHCP Waivers
  • Ambulance
  • Audiology/Hearing Aids
  • Autism Care Demonstration
  • Behavioral/Mental Health Care
  • Breastfeeding Counseling
  • Donor Breast Milk
  • Durable Medical Equipment
  • Electroconvulsive Therapy
  • Emergency Medicine/Urgent Care/Observation
  • Fetal Monitor/Non-Stress Test
  • Global OB/Maternity Care
  • Hemodialysis
  • Home Health Care
  • Hospice
  • Infusion/medication that requires coordination with Express Scripts
  • In Vitro-Fertilization for Active Duty Category II or III Illness or Injury
  • Intensive Outpatient Programs
  • Line of Duty
  • Orthotics or Prosthetics
  • Partial Hospitalization Programs
  • Stem Cell Transplant
  • Substance Use Disorder