Referrals are for services that are not considered primary care. An example of a referral is when a PCM sends a patient to see a cardiologist to evaluate a possible heart problem. For more information on referrals, visit our Prior Authorizations and Referrals page.
A statement sent to providers showing the outcome of claims processing.
Includes the Army National Guard, the Army Reserve, the Naval Reserve, the Marine Corps Reserve, the Air National Guard, the Air Force Reserve, and the U.S. Coast Guard Reserve.
A former service member of one of the uniformed services who has retired.
Review performed after services have been provided.
A review by the military treatment facility (MTF) of civilian authorizations and referrals received by Health Net Federal Services, LLC to determine if the MTF is able to provide the services.