Eight Self-Referred Behavioral Health Care Visits Renew with Fiscal Year

The first day of the new TRICARE fiscal year, Oct. 1, renews the behavioral health care outpatient visit count for all TRICARE beneficiaries, except active duty Service members. The first eight outpatient behavioral health care visits to network providers per fiscal year do not require prior authorization or a referral from the beneficiary’s primary care manager or TriWest.

There are certain types of providers, however, for which a physician referral and supervision are always required, even for the first eight visits. These providers include licensed professional counselors, licensed mental health counselors and pastoral counselors.

Prior authorization is required for the ninth and subsequent visits for all beneficiaries. A physician referral is not required for these visits, but authorization is required to establish medical necessity. If you are unable to determine from the patient if they have exhausted their initial eight visits for the current fiscal year, TriWest recommends that you submit a prior authorization request.

Active duty Service members always need a referral from their primary care manager (or service point of contact if enrolled in TRICARE Prime Remote) and authorization from TriWest before obtaining civilian behavioral health care.

For more information on behavioral health care and prior authorization requirements, including submitting your requests online, visit www.triwest.com/provider.

Published Date: 09/16/2009