Page 85 - R2P Front Desk Manual v1

● If a patient comes in without a referral, tell them to call Tricare and ask if there is a
referral/authorization on file. Any referrals on file should be viewable in the portal.
● If we see a patient without a referral from their PCM, then there is a possibility of the
patient having to pay a Point of Service fee (similar to being out of network).
● Backdating referrals: if beneficiary goes to a provider without a referral & receives bill
from provider, claims can deny if a backdated referral is not received within 30 days
(again, the beneficiary would be responsible for a POS fee).

Other Information:
● Order of who to bill:
○ 1) Medicare
○ 2) Other (Other Health Insurance)
○ 3) Tricare
○ 4) Medicaid
● Patient referral authorization form on Humana website: exact same form as PCM fills
out, used for making new referrals.
● Right of First Refusal: if beneficiary gets "ROFRed,” then the patient's referral has been
"called back" by the Military Treatment Facility so the clinic CANNOT see the patient;
advise the patient they have to contact their MTF (i.e. can happen if the patient cancels
their appt @ MTF and tries to come right to clinic).

Provider Portal Help Desk - call Humana to be transferred internally; have to contact provider
rep Kisha York to change/update provider info (email, phone, fax 502-450-9008)

Last Update: 7/11/19