Referrals
Not all beneficiaries are required to get a referral for specialty care. Beneficiaries using TRICARE Standard and Extra, TRICARE Standard Overseas, TRICARE Reserve Select, TRICARE Retired Reserve, TRICARE For Life and TRICARE Young Adult-Standard Option will never need a referral for any type of care, but some services may require prior authorization.
If you are enrolled in one of the following TRICARE Prime options, you will need a referral from your primary care manager (PCM) for services that he or she cannot provide with a few exceptions:
- TRICARE Prime
- TRICARE Prime Remote
- TRICARE Prime Overseas
- TRICARE Prime Remote Overseas
- TRICARE Young Adult-Prime Option
- US Family Health Plan
Your PCM will coordinate with your regional contractor for the referral. If you have a newtork PCM, you may be referred to a military treatment facility for the specialty care. If enrolled in TRICARE Prime Remote, you may need to work with your contractor directly if you don't have an assigned network PCM. If enrolled in the US Family Health Plan you will be referred to a specialist within your designated provider.
Services That Do Not Require a Referral
Prime beneficiaries may get the following services from a TRICARE network provider without a PCM referral.
- Clinical preventive services
- First eight outpatient behavioral health care visits per fiscal year (October 1 - September 30)
Beneficiaries who get care from a non-network provider without a referral from your PCM, are using the point of service option, resulting in higher out-of-pocket costs.
Checking the Status of a Referral
You cannot request a referral or check the status of a referral on this Web site. To check the status of a referral, please go to your regional contractor's site below. If not already registered on your contractor's site, you'll need to register and sign in for secure services:
- North Region: Health Net Federal Services
- South Region: Humana Miltary Healthcare Services
- West Region: TriWest Healthcare Alliance
- Overseas: Contact your Regional Call Center
Last Modified:June 19, 2012
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