Military Hospitals and Clinics Optimization

The Military Hospitals and Clinics Optimization process allows the military hospital or clinic to provide specialty careSpecialized medical/surgical diagnosis, treatment, or services a primary care provider isn’t qualified to provide.. Specialized medical/surgical diagnosis, treatment, or services a primary care provider isn’t qualified to provide. to those with TRICARE Prime.

What Should I Know About Military Hospitals and Clinics Optimization?

Military Hospitals and Clinics Optimization is a requirement under TRICARE Prime. It applies only if you have TRICARE Prime.

• You must also live within a 60-minute drive of a military hospital or clinic, or if you waived access standards to stay enrolled in TRICARE Prime
• During TRICARE Open Season, those with TRICARE Prime can switch to TRICARE Select, which doesn’t require Military Hospitals and Clinics Optimization
• There is no copaymentA fixed dollar amount you may pay for a covered health care service or drug. for care received at a military hospital or clinic
• If the military hospital or clinic accepts a referral under the Military Hospitals and Clinics Optimization, TRICARE East can’t change it; only the military hospital or clinic can do that

Military Hospitals and Clinics Optimization can only be reversed for the following:

• Continuity of care
• Special circumstances that prevent you from using a military hospital or clinic

When a provider determines you need specialty care, they’ll submit a referral request to TRICARE East for approval and Military Hospitals and Clinics Optimization processing. Often, the military hospital or clinic has the specialized services available. In this case, they’ll notify TRICARE East, usually within one business day, and you’ll be referred to that military hospital or clinic.

The facility may contact you to schedule an appointment. At that time, TRICARE East will provide information about that facility. If they can’t provide the needed services, you’ll be referred to a civilian network provider. If you choose a provider before the Military Hospitals and Clinics Optimization decision, and the military facility can provide the services, you must go to the military facility instead.