What is the purpose of the United Healthcare Military form?
The United Healthcare Military form, specifically the TRICARE Service Request/Notification, is designed to facilitate referrals for medical services to beneficiaries of TRICARE. This form is utilized to request specialty care, inpatient services, outpatient services, or durable medical equipment (DME). Proper completion ensures that the necessary medical evaluations and treatments are issued without delay.
Who should fill out the Military form?
The form should be completed by the requesting provider who is seeking a referral for a patient. This can include a physician, facility, agency, or vendor. The beneficiary's information, including personal details and medical necessity for the requested services, must be accurately provided to avoid interruptions in care.
What information is required on the form?
The form requires several key pieces of information. This includes beneficiary details (name, gender, date of birth, address), requesting provider information (name, address, contact details), and specifics about the services being requested (medical necessity, diagnosis, anticipated date of service, etc.). Additionally, priority and service type must be indicated, such as whether the request is routine or urgent.
How do I submit the United Healthcare Military form?
The completed form should be faxed to the appropriate numbers provided based on the urgency of the request. Routine requests can be sent to 877-890-8203, while urgent requests should be faxed to 877-890-9309. Ensure that all required information is filled out to facilitate the referral process.
What happens if I submit the form with incomplete information?
Submitting the form with incomplete information can result in delays in processing the referral. If the form lacks necessary details, United Healthcare may request additional information, which can prolong the time before services are rendered. It is crucial to verify all entries for accuracy and completeness before submission.
Who do I contact if I have questions about the form?
If you have questions regarding the form or its submission process, you can contact TRICARE West Region Customer Service at 1-877-988-9378. They can provide assistance and clarification on how to properly fill out the form and address any concerns you may have.
What is the importance of medical necessity in this form?
Medical necessity is a critical component of the United Healthcare Military form. It provides justification for the requested services or procedures. The explanation of medical necessity should clearly outline why the specialized care is needed based on the patient’s diagnosis and treatment plan. This helps in securing approval for the referral and ensures that the patient's healthcare needs are met adequately.
What privacy measures are in place for the information provided?
The form contains personally identifiable information and protected health information. Access to this information is limited to individuals who have a legitimate need to know. Compliance with privacy regulations, such as the HIPAA Privacy Rule and the DoD Privacy Program, is mandatory. If the form is received by an unintended recipient, they should contact United Healthcare at 1-877-988-9378 immediately to rectify the situation.