THP MMSO authorizes treatment of a specific LOD medical condition to include:
- Diagnostic tests
- Durable medical equipment support
- Treatment (to include surgery, if indicated) and
- Any required/related follow-on care. Follow on care includes:
- physical therapy
- follow-on testing
There is no longer a requirement for incremental requests to authorize care for each step in the treatment process. Episode of Care authorizations result in a better coordinated treatment process for the RC servicemember and reduces delays in providing needed care.
Under EOC, referred to as evaluate and treat, the PCM/specialty care provider manages the entire episode of care to include diagnostics, treatment, and follow-on care. THP MMSO does not select PCMs, the TRICARE contractor does.
THP MMSO initiates the referral/preauthorization request directly to the respective TRICARE regional contractor through the government portal. Once the TRICARE contractor receives the referral, they provide an authorization directly to a PCM or specialty provider for the services requested.
The member and/or the unit may see these authorizations once completed on the TRICARE contractor’s authorization self-service portal:
It is the service member’s responsibility to keep the Unit informed on the status of their care throughout the entire EOC treatment process.
Most LOD follow-on care pre-authorizations issued by THP MMSO are 365-day EOC authorizations. LOD care can only be approved for maximum of 12 months. If eligible, service members can seek additional care through the VA. The service member also should be referred to the Disability Evaluation System.