Tricare Information

All Tricare patients must have a referral from their PCP to authorize lab services. If a patient has been referred to you for an office visit and you feel genetic testing is required, you will need to contact the PCP to ask for an additional referral to cover lab services. Genetic testing is not a routine benefit with many Tricare plans must be pre-authorized.

Tricare has stated that they will cover cytogenetic tests (routine chromosome analysis and FISH) when they are reasonable and necessary for the diagnosis and treatment for approved diagnoses (see Approved Diagnosis List below). For any other diagnosis Tricare will declare cytogenetic studies to be medically unnecessary. We ask that when a provider feels that cytogenetic testing is required please verify that the patient's diagnosis is listed among the approved ICD-9 codes. If the diagnosis is notlisted, please present a Non-Covered Services Waiver to the patient. Your staff will need to inform the patient of the cost of the lab tests so they may decide if they want to pay for these services out of pocket.

Many Tricare plans will not cover molecular testing or sequencing. You will need to contact Tricare to confirm if the test is a covered benefit and whether or not it requires pre-authorization.

If you have any questions or concerns feel free to contact our staff at 405-271-3589 and we will be happy to help.

Approved Diagnosis List

Patient Referral Form--Used by providers that do not have Internet service when requesting a referral or prior authorization for health care services. This method requires providers to print form, then fax to: 1-877-548-1547.

Non-Covered Services Waiver--Used by providers to inform beneficiaries of particular services not covered by TRICARE.

Beneficiary Forms--Forms for Tricare policy holders

Tricare provider website https: //infocenter.humana-military.com/South/provweb/InfoCenter.asp

Tricare beneficiary website http://www.humana-military.com/South/bene/beneresources.htm