The Tricare Letter of Referral (LOR) form is an essential document for Tricare beneficiaries who seek access to licensed mental health services. This includes care from Licensed Mental Health Counselors (LMHCs), Licensed Professional Counselors (LPCs), or Pastoral Counselors (PCs). The form requires completion and submission with the initial claim for the patient indicated, and it provides vital information such as the patient's name, date of birth, sponsor number, and reason for referral, including the ICD-9/DSM-IV diagnosis. A significant aspect of the Tricare LOR form is its emphasis on the necessity for a diagnosing physician's referral before the commencement of treatment with LMHCs, LPCs, or PCs. The policy mandates that a physician must not only recommend the patient to mental health counseling but also must maintain ongoing oversight and supervision for the duration of treatment. This directive aims to streamline the care process and ensure that patients receive coordinated and comprehensive mental health services. It is worth noting that non-compliance with these guidelines may lead to non-payment of claims, yet beneficiaries are protected from financial liability. Additionally, the form encompasses the referring physician’s information, including their practice location and contact details, underscoring the collaborative effort required between medical and mental health professionals to meet the policy standards set by TRICARE.
| Question | Answer |
|---|---|
| Form Name | Tricare Lor Form |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | tricare for life forms, PCs, PCM, LMHC |
