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  • Tricare East Referral Form Printable

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For this service. You may wish to wait for authorization prior to scheduling the patient appointment. Referral is based on medical necessity, subject to TRICARE eligibility, and is not a guarantee of payment. SECTION I: PATIENT INFORMATION Last Name: First Name: MI: DOB: Address: City: State: Zip: Sponsor s SSN: Sponsor s Name:.

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A referral is not required for services. Certain services (e.g., Applied Behavior Analysis (ABA), inpatient admissions, some behavioral health services, adjunctive dental care, home health services, etc.) require prior authorization. You can get care from any TRICARE-authorized provider, network or non-network.

You don't need to see a "primary care provider" first and you'll never need a referral for any type of care.

If you're an active duty service member enrolled in TRICARE Prime, your PCM works with your regional contractor for the referral....If you're registered on the TOL Patient Portal, you can view your referral details by: Logging into the TOL Patient Portal. Clicking on Appointments. Clicking on My Referrals.

The quickest, easiest way to request a new referral or authorization or update an existing referral or authorization is through provider self-service. *Providers should submit referrals and authorizations (including behavioral health) through self-service.

About us. Humana Military, a wholly-owned subsidiary of Humana Inc., partners with the Department of Defense to administer the TRICARE health program for military members, retirees and their families in the East Region.

Some TRICARE plans, including TRICARE Select, don't require referrals for most health care services. However, if you're enrolled in one of the following plans, you need a referral before you visit a specialist: TRICARE Prime. TRICARE Prime Overseas.

If you do not have internet connection in your office, you may complete and submit this form by fax to 1-877-548-1547.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Content Takedown Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232