Referrals and Authorization
Active Duty Service Members
You need a referral from your primary care manager (PCM) for any care he/she doesn't provide. This includes urgent, routine, preventive, mental health and specialty care services.
- Your PCM works with your regional contractor for the referral and authorization.
- Your contractor will try to refer you to a military hospital or clinic first.
- If not available, you're referred to a network provider (in your region).
You can’t get any care without seeing your PCM first. If you do, you may be responsible to pay for the care out-of-pocket.
All Other Beneficiaries Enrolled in a TRICARE Prime Plan
Your PCM gives you a referral for most services that he or she can't provide. (
See Exceptions)
- Your PCM works with your regional contractor for the referral and authorization.
- Your contractor will try to refer you to a military hospital or clinic first.
- If not available, you'll be referred to a network provider (in your region).
If you see a specialist without a referral from your PCM, you’re using the point-of-service option.
- Enrolled in TRICARE Prime Remote? Work with your regional contractor if you don't have an assigned PCM.
- Enrolled in the US Family Health Plan? You'll get a referral to a specialist within your designated provider.
- Enrolled overseas? Call your regional call center.
- Need urgent care? You must have a referral. >>Learn More
All Other Beneficiaries
What is Right of First Refusal?
This is when your regional contractor refers you to a military hospital or clinic first. The military facility has the right to take the referral or refuse it. If they refuse it, then you'll get a referral to a network provider.
Network vs. Non-Network Providers
You should try to see network providers instead of non-network providers. Network providers can't:
- Ask you to sign a document to make you pay for authorized services.
- Ask you to sign a document to make you pay for any part of the service not covered by TRICARE.
- Refuse to see you because you won’t sign such a document.
>>Learn More