What services are offered?
A: The Referral Management Center (RMC) is available to assist you, when necessary, in scheduling your Military Treatment Facility (MTF) specialty care appointments. If your specialty care referral is deferred to Health Net Federal Services, the RMC may assist, when necessary, in order to coordinate your off-site civilian network provider appointment(s).
My Primary Care Manager placed a referral for specialty care services, what do I need to do?
A: When your provider places a routine referral (consult) for specialty care services you should call the appointment call center at 1-866-511-8748 or 410-674-7116 after two business days to schedule your specialty care appointment (Don’t delay).
If no appointments are available within Kimbrough the Referral Management Center (RMC) will check availability with other Military Treatment Facilities in the National Capital Area and will notify you by telephone if an appointment is available.
If no appointments are available within the Military Health System your referral (consult) will be deferred to Health Net Federal Services to locate a civilian NETWORK provider. Once your referral is deferred to Health Net Federal Services, you may call 877-874-2273 after 3 business days for the authorization number, name and location of the civilian network provider or you may wait for the authorization to arrive via mail.
Emergent and Urgent referrals are coordinated provider to provider by your Primary Care Manager with assistance from the Referral Management Center and Health Net Federal Services.
I’m enrolled in TRICARE Prime at Kimbrough Ambulatory Care Center, why are my referrals for specialty care sent to other Military Treatment Facilities (MTF’s) in the National Capital Area (NCA)?
A: TRICARE Prime functions similar to a civilian Health Maintenance Organization (HMO). Enrollees are assigned or choose a Primary Care Manager (PCM) who manages their care and refers to specialists when necessary. Referrals from your PCM for specialty care are directed to the NETWORK of providers. Military Treatment Facilities within the NCA are considered NETWORK facilities and are the first choice considered for almost all specialty care referrals written from PCM’s within the NCA. If the care your provider requested is not available due to capacity and/or capability within a Military Treatment Facility it is deferred to Health Net Federal Services for assistance in finding a NETWORK civilian provider.
If you are having problems with your referral or need additional assistance with your referral please call our Referral Management Center at 301-677-8840/8841. If your referral was deferred to Health Net Federal Services and you have not received your authorization within 10 business days, please call 877-874-2273 for assistance. Please note you may register at www.mytricare.com to view/print your authorizations for civilian medical care.
What can I do if my referral is accepted by a Military Treatment Facility and I would rather see a provider in the civilian community?
A: Active duty family members, retirees, and retiree family members have several options. They may use the TRICARE Prime Point of Service option to seek non-emergent care from civilian providers and pay the TRICARE Prime Point of Service deductible and cost share, resulting in higher out of pocket expenses, choose to enroll in the U.S. Family Health Plan, or may disenroll from TRICARE Prime and use TRICARE Standard/Extra. Beneficiaries requiring assistance understanding their benefit options and costs associated with each option may call 301-677-8982 to schedule an appointment with KACC’s Health Benefit Advisors (HBA).
Due to deployability and fitness for duty issues, active duty service members enrolled in TRICARE Prime at Kimbrough Ambulatory Care Center are required to have a referral and authorization for all non-emergent care rendered from civilian sources. Service members seeking non-emergent care from civilian sources without proper authorization do so at their own risk.