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TRICARE Policy Manual 6010.60-M, April 1, 2015
Providers
Chapter 11
Section 11.3
Certified Marriage And Family Therapist Certification Process
Issue Date:  February 23, 1994
Revision:  C-13, November 15, 2017
1.0  ISSUE
What is the process to certify a certified marriage and family therapist?
2.0  POLICY
Each contractor is the certifying authority and has participation agreement signatory authority for Defense Health Agency (DHA) for certified marriage and family therapists located within their geographical jurisdiction.
3.0  POLICY CONSIDERATIONS
3.1  Application. A complete application for certification as a certified marriage and family therapist consists of an application signed and dated by the requesting provider which provides:
3.1.1  The complete name and address (home and business) of the applicant.
3.1.2  A routine and emergency phone number for the applicant.
3.1.3  Legible photocopies of:
3.1.3.1  Current state license which includes the expiration date and the original issue date of licensure.
3.1.3.2  Transcripts of professional education to include name and address of institution.
3.1.3.3  Documentation of proof of supervised clinical experience which includes name and address of institution, dates of experience, name of supervisor, and signed certification that the applicant has successfully completed the required training hours.
3.1.3.4  In the absence of jurisdictional licensure/certification, proof of full clinical membership (or eligibility for such) in the American Association for Marriage and Family Therapy (AAMFT). Proof may be either a copy of the formal response from the AAMFT acknowledging full clinical membership (or eligibility for such) in their Association, or listing in the current AAMFT Directory as a full clinical member.
3.2  Development. The certifying authority shall make at least one request for information missing from an application.
3.3  Decision notice. The certification decision shall be rendered within 60 days of receipt by the certifying authority of a complete application.
3.4  Rejected application. An applicant shall be notified in writing that he/she is no longer considered an applicant for certification when a pending incomplete application is not made complete within 60 days of the date a written notice to the applicant of the deficiencies of the applicant’s application unless the certifying authority has extended the response time for good reason.
3.5  Denied application. An applicant shall be notified in writing of the specific reason(s) that certification is not granted.
3.6  Certification process.
3.6.1  Authorization of an applicant as an authorized certified marriage and family therapist shall be made only after the certifying authority has verified that:
3.6.1.1  The information provided in the complete application is true and current.
3.6.1.2  The applicant complies in all respects with the requirements of the 32 CFR 199.
3.6.1.3  The applicant is not otherwise barred from provider status.
3.6.1.4  The applicant has returned a signed participation agreement.
3.6.1.5  The applicant has used their Social Security Number (SSN) or their Employer’s Identification Number (EIN) as the billing number.
3.6.2  Amended application. An applicant has amended a pending or approved application within 30 days of a change in any of the information required for application.
3.6.3  Compliance verification. The certifying authority shall maintain contemporary documentation that the currency of each approved certified marriage and family therapist has been verified at least at 24-month intervals following initial approval as an individual provider.
3.6.4  Certified marriage and family participation agreement. The text of the participation agreement for certified marriage and family therapists is at Addendum A. The contractor is not authorized to make any change in the language of this agreement. Applicant specific changes to this agreement will not be considered by DHA.
3.7  Recertification. The claims processor is to follow the TRICARE Operations Manual (TOM), Chapter 4, Section 1, and the above outlined process for recertification of currently authorized marriage and family counselors and previously authorized pastoral counselors desiring to become certified marriage and family therapists. Previously authorized pastoral counselors or new applicants for pastoral counseling choosing to be an authorized certified marriage and family therapist must meet all the regulatory requirements for a certified marriage and family therapist including licensure, national association membership requirements and provisions of participation (see Sections 3.9 and 3.10).
3.8  Unassigned claims submitted by providers:
3.8.1  Who are marriage and family counselors or previously identified pastoral counselors who have elected to become certified marriage and family therapists and who have signed a participation agreement should be denied.
3.8.2  Who have not signed a participation agreement should be denied by the claims processors as “provider not authorized” and offered information on how to become an authorized provider.
3.8.3  Who are marriage and family counselors or pastoral counselors who have elected to become a certified marriage and family therapist and who had entered into a participation agreement with DHA and subsequently terminated the agreement should be denied as “provider not authorized”.
3.9  Unassigned claims submitted by beneficiaries:
3.9.1  For care rendered by a marriage and family counselor or previously identified pastoral counselors who have elected to become certified marriage and family therapists and have signed a participation agreement should be returned uncontrolled to the beneficiary with instructions that the provider must submit the claim before payment can be made.
3.9.2  For care rendered by a marriage and family counselor or pastoral counselor not signing a participation agreement should be denied as “provider not authorized” and offered information on how to become an authorized provider.
3.9.3  For care rendered by a marriage and family counselor or pastoral counselor who has elected to become a certified marriage and family therapist and who had entered into a participation agreement and subsequently terminated the agreement should be denied as “provider not authorized” and returned to the beneficiary.
3.10  Administrative error.
Should the designated DHA certifying authority authorize a provider as a certified marriage and family therapist and subsequently realize that an administrative error (i.e., provider did not meet education criteria, etc.), was made during their certification process, the designated certifying authority must notify the provider in accordance with the TOM.
4.0  EFFECTIVE DATE
May 22, 1994.
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