Prior Authorization, Referral & Benefit Tool

Prior Authorization, Referral and Benefit Tool

The Prior Authorization, Referral and Benefit Tool allows you to easily determine if an approval from Health Net Federal Services, LLC (Health Net) is required. Simply select the beneficiary's TRICARE plan option* (for example, TRICARE Prime or TRICARE Prime Remote), the beneficiary type (for example, active duty service member), servicing provider type (for example, network or non-network) and the specific service being requested.

Providers should verify eligibility prior to using the Prior Authorization, Referral and Benefit Tool. Eligibility verification can be performed online using the Patient Eligibility tool or through the interactive voice response (IVR) by calling 1-877-TRICARE (1-877-874-2273). Providers should verify their patient’s eligibility on the date of service and use that date for the effective date.

Please note: This tool only identifies whether a Health Net approval is needed. It does not provide the approval. After a referral for evaluation and treatment is issued, it serves as an umbrella to allow TRICARE Prime beneficiaries to receive other potential services that are related to a specific condition for a defined period of time; however, for certain medical/surgical and behavioral health services, a prior authorization is also needed.

If you have questions on how to use the Prior Authorization, Referral and Benefit Tool, visit our help page.

Providers who need to obtain a prior authorization or referral from Health Net should follow the instructions on our How to Submit page. 

*TRICARE Prime responses include TRICARE Young Adult Prime. TRICARE Standard responses include TRICARE Reserve Select, TRICARE Retired Reserve and TRICARE Young Adult Standard.