Appointments & Referrals

If you have questions, you may visit the Referral Management Center (RMC) or call (402) 294-4010.  The RMC will:

• Verify your eligibility & contact information.
• Verify your referral is in the system.
• If services are available in the Military Treatment Facility (MTF), we will book your appointment with a specialist at the MTF.
• If the services are not available at the MTF, we will explain Health Net Federal Services’ (HNFS) authorization process.

Referral Management will review your referral to determine if the specialty is available in the MTF or if it needs to be deferred off base.

• If the MTF has the requested services, then the RMC will call you within 3 business days to book your appointment.
• After three unsuccessful contact attempts (within a 14-day span), your consult will be pended for 30 days before being closed.

Be sure you are registered at www.tricare-west.com.

• Set your preferences to receive email and/or text alerts when your referral has been authorized by Health Net Federal Services.

• Your authorization letter will contain the number of authorized visits, approved services, the specialist’s contact information, and the approved timeframe for treatment.
• You may also check the status of a pending off base referral by calling Health Net Federal Services at 1-844-866-9378.

If you have a commercial health insurance plan you must follow the rules of that plan; TRICARE is your secondary coverage.

1. Schedule your appointment with the recommended off-base specialist. If you choose a different off-base specialist, make sure to check www.tricare-west.com to ensure it is an in-network specialist with the same specialty.
2. After you schedule your off-base appointment, call the RMC at (402) 294-4010 to inform us of the day & location of your appointment. This helps us retrieve your results.

• You can access your military medical record through MHS GENESIS Patient Portal and print or download any necessary medical information.
• You may also send a MHS GENESIS Patient Portal message to your PCM requesting pertinent copies of your medical history be sent to the off-base specialist.
• In your Secure Message, be sure to include the following off-base specialist contact information:
  • Specialty Provider Name
  • Office Name
  • Telephone Number
  • Fax Number

Ask your specialist to fax the results of your visit to (402) 232-6406 to be added to your electronic military health record for your PCM to review.

If you disagree with the balance on your bill, call the phone number listed on the bill to ensure the off base provider has a copy of your referral authorization and correct sponsor/guarantor information.

If they have your referral authorization, but are still unable to resolve the bill, then go to www.tricare-west.com to see how your claim was processed. You may also call Health Net Federal Services at 1-844-866-9378.

If you disagree with how the claim was processed, you may file a formal appeal in writing within 90 days of the date on the explanation of benefits or provider remittance.
 
You can submit your appeal by using Health Net’s online appeal submission form, or by submitting an appeal letter via mail or fax. If you need further assistance, please call us at (402) 294-4010 and request to speak to a Beneficiary Counselor and Assistance Coordinator (BCAC).
 

• Seeking care from a civilian provider without prior authorization can result in significant out of pocket costs to you. Please ensure that you have the proper authorization before seeking any off-base non-emergent care.

• Active duty members must have prior authorization for all urgent or non-emergent off-base services.

• For additional information on TRICARE benefits, visit www.tricare.mi