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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, 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.

All Other Beneficiaries

Referral and Authorization Notice

Health Net Federal Services and Humana Military are honoring authorizations and referrals issued by the previous TRICARE contractors through their 2018 expiration dates. There is no action needed for these already-approved requests. If your referral or authorization expired prior to 1/1/18, your provider can submit updated requests to your new TRICARE contractor.

  • If you are in the West RegionClick to closeAlaska, Arizona, California, Colorado, Hawaii, Idaho, Iowa (excludes Rock Island arsenal area), Kansas, Minnesota, Missouri (except St. Louis area), Montana, Nebraska, Nevada, New Mexico, North Dakota, Oregon, South Dakota, Texas (southwestern corner including El Paso), Utah, Washington and Wyoming., visit TRICARE West for more information.
  • If you are in the East RegionClick to closeUnder the new regional contracts, the East Region is a merger of the North and South Regions and includes: Alabama, Arkansas, Connecticut, Delaware, the District of Columbia, Florida, Georgia, Illinois, Indiana, Iowa (Rock Island area), Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Mississippi, Missouri (St. Louis area), New Hampshire, New Jersey, New York, North Carolina, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas (excluding El Paso area), Vermont, Virginia, West Virginia, and Wisconsin., visit TRICARE East for more information.
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

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.

Last Updated 6/5/2018