Referral Management Center

What is Referral Management?

Referral Management is the action of managing medical care for specialty services within the military treatment facility (MTF). It also ensures your specialty care notes from civilian network providers are obtained and made available to your Primary Care Manager team.

Referral Process

When your PCM initiates a referral, it’s forwarded to referral management for processing. This process includes:

• Verifying eligibility and demographic information.
• Reviewing the referral to ensure clinical accuracy and that it contains necessary information to meet medical necessity for administrative processing.
• Determining if this care can be received at the local MTF or if it requires deferment to a network provider. If the care can be provided at the MTF it will be forwarded to the appropriate specialty clinic. If it requires deferment to a network provider it will be submitted to Humana Military for approval.
• Booking appointments for internal specialty care referrals and instructing patients on how to book network provider appointments once appointed to a civilian provider.
• Assisting with any questions or concerns regarding your referral.

Network Specialist Appointment

If your care can’t be rendered at the MTF and requires scheduling with an off-base network provider, your referral will be submitted to Humana Military for approval. Patients are able to review and manage their referrals as well as their dependent’s (under age 18) referrals via the Humana Military Self Service Portal, www.humanamilitary.com/beneficiary. The self service portal provides:

• Number of authorized visits.
• Timeframe for approved treatment.
• Approved services.
• Specialty providers name and contact information.

Medical Records For Referrals

Your off-base specialist may require medical records pertinent to care for which you are being referred. Please contact the Referral Management Center no later than eight business days before your scheduled off-base appointment to submit the request. The request must include specifically what the specialist is wanting (i.e., lab results, radiology reports, medication list, office notes, etc.) related to the reason you are being referred. This request can be submitted directly by your off base provider or the patient Request can be submitted via fax or in person and on a DD Form 2870, ‘Authorization for Disclosure of Medical or Dental Information.’ Civilian medical organizations requesting patient medical records may use their own release forms in lieu of DD Form 2870.
 
Your complete medical record will not be released unless there is a DD Form 2870 filled out and submitted. The facility can submit the form via fax or mail. The request will be forwarded to the Medical Records Release of Information Department. Please allow up to 30 days for the request to processed and  records sent.

Command Privacy Act/HIPAA Officer

OFFICER:  Patricia Pridgen
CONTACT: 919-722-0733
For more information about the Command Privacy Act or HIPAA, visit the following websites: https://tricare.mil/Privacy/HIPAA