View Only

The Online Referrals and Authorization View Only services allow users to perform a variety of functions related to health care referrals and authorizations for TRICARE beneficiaries. The services are designed for use by MTF and Clinic staff who are responsible for coordinating TRICARE patient care or managing the flow of referral requests for civilian care.

• Check and Existing Referral/Authorization
• Inpatient Admissions: Active Duty or Non-active Duty
• Referral Reconciliation
• Services by Provider
• View Approved Authorizations for your MTF
• ROFR Dashboard

Create/Update

The Online Referrals and Authorization Create/Update service allows authorized MTF and Clinic users to submit new referral requests to Humana Military.

ROFR Dashboard

The ROFR Dashboard service allows access to referral details for beneficiary care that have been reviewed by military hospitals and clinics under the Right of First Refusal (ROFR) process. In addition to being able to view ROFR referrals users have the ability to view the ROFR capabilities of the military hospital or clinic.

Pended Claims Review

The Pended Claims Review service allows users to view and indicate a pay/deny decision on pended claims that are awaiting action by the MTF or government facility.

TIP Beneficiary 360
Includes Shared Clinical View

The TIP Beneficiary 360 - Includes Shared Clinical View service allows read-only access to beneficiary demographics, enrollment, claims and other data for response to TRICARE Beneficiary questions. Authorized users will be able to retrieve a large amount of timely data from both Humana Military and DoD data sources for an individual TRICARE Sponsor and his/her dependents. The service is designed for use by Health Benefits Advisors (HBAs) and Beneficiary Counseling and Assistance Counselors (BCACs).

Shared Clinical View
(for Clinical Staff Only)

The Shared Clinical View service allows the ability to view beneficiary healthcare data care management programs, case notes, communications, and alerts.
To gain access, please contact the Approving Authority for your MTF.

This HEARD service allows Approving Authorities (or their approved designees) to update TRICARE Prime beneficiary enrollment assignment rules for DMIS IDs associated with the bases they are responsible for. Approving Authorities have this service by default. Other users should only sign up for this service on the direction of their Approving Authority.

The PQI Referral Form service allows MTF users to submit potential quality issues (PQIs) concerning network providers to DHA in an electronic format.

The TRICARE Report Gallery service is an online reporting system that will allow users to access Humana Military's TRICARE Reports. The reports found within this service are canned (non ad hoc) reports that run on a set frequency (daily, weekly, monthly, etc.). This service includes two different report categories: Required Reports as provided in the TRICARE contract or Additional Reports which are outside the requirements of the TRICARE contract.

Care Management

The Care Management report category contains reports pertaining to care management, case management, and disease management programs.

Education

The Education report category contains reports for education hours, education briefings, and provider seminars.

Enrollment

The Enrollment report category contains reports for enrollment detail and totals for civilian and military PCMs.

Provider

The Provider report category contains reports that pertaining to civilian providers such as network adequacy, directory, etc.

Quality Management

The Quality Management report category contains reports pertaining to quality.

Service Central

The Service Central report category contains reports pertaining to service.

Utilization Management

The Utilization Management report category contains reports pertaining to referrals such as directed referrals, access to care, ROFR, etc.

Claims

The Claims report category contains reports pertaining to claims and cost summary reporting.

Enrollment

The Enrollment report category contains reports for enrollment detail and totals for civilian and military PCMs.

Utilization Management

The Utilization Management report category contains reports pertaining to referrals such as travel attestation, referral trends, etc.

This service allows users to view, create, and run ad hoc queries which pulls data from Humana Military data warehouse also known as TRICARE DataMart. Within the TRICARE DataMart users will find information pertaining to beneficiary, claims, utilization management, providers, location, etc.
To gain access, please contact the Approving Authority for your MTF. After you have been granted access, the TRICARE DataMart training is available after selecting TRICARE DataMart from the Government Self-Service page.