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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

Always try to see a network provider first!

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

Last Updated 8/25/2016