Referrals & Authorizations

You can find your referral letters by logging into your self-service account. After your doctor submits a referral, it may take 24-48 hours for it to appear.

What Do I Need to Know?

• If you have TRICARE Prime, you need a referral for clinical preventive services when visiting a non-network provider.
• If a provider isn’t TRICARE-authorized on the date of service, the claim will deny.
• If the provider doesn’t submit certification paperwork, you must pay all charges. 

Whether you need a referral depends on your TRICARE plan and your status.

Active duty service members

• Your primary care manager at a military hospital or clinic will refer you for any services they can’t provide
• If the military hospital or clinic can’t offer the needed services, they’ll work with TRICARE East to get a referral or authorization for a civilian provider
• You don’t need a referral for urgent care at the military hospital
• You don’t need a referral for a clinic or for emergency care at an emergency roomThe hospital department that provides emergency services to patients who need immediate medical attention.
• If you get care that requires a referral without getting one, you may have to pay all or part of the bill

TRICARE Prime

• TRICARE Prime requires referrals for specialist visits and some diagnostic services
• If you go to a specialist without a referral, you’ll use your Point of Service option
• Your PCM will handle the referral process with TRICARE East
• If you have TRICARE Prime can get clinical preventive services from any network provider without a referral
• You don’t need a referral for urgent care
• Certain services, like inpatient admissions and some behavioral health services, require prior authorization

TRICARE Prime Remote

• Your assigned civilian PCM will work with TRICARE East to get a referral or authorization for any services they can’t perform
• You don’t need a referral for urgent care if you see a TRICARE-authorized providerAn authorized provider is any individual, institution/organization, or supplier that is licensed by a state, accredited by national organization, or meets other standards of the medical community, and is certified to provide benefits under TRICARE. There are two types of TRICARE-authorized providers: Network and Non-Network. DS
• Emergency care at an emergency room for a true emergency doesn’t require a referral
• If you receive care that requires a referral without getting one, you may be responsible for all or part of the bill

TRICARE Select and Other Beneficiaries

• You don’t need a referral for services
• However, some services, like Applied Behavior Analysis and inpatient admissions, require prior authorization
• You can see any TRICARE-authorized provider, whether in-network or non-network

US Family Health Plan

• If you have the USFHP, please call 800-74-USFHP or 800-748-7347 for information about your plan.

How Can I Check the Status?

To check the status of a referral, log in to your self-service account. After a provider submits a referral, it could take 24-48 hours for it to show up.