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.

• Enrolled in TRICARE Prime Remote? Call the Defense Health Agency-Great Lakes.
• Enrolled overseas? Call your regional call center.

All Other Beneficiaries Enrolled in a TRICARE Prime Plan

• 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

• You don’t need a referral for any type of care except Applied Behavioral Analysis. 
• Other services may require prior authorization.