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

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 TRICARE doesn't cover
  • Refuse to see you because you won’t sign such a document
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.

Humana Military, Health Net Federal Services, and International SOS Assistance extended some already-approved referrals and authorizations that expire(d) between March 1, 2020 and June 30, 2020. This automatic extension is for an extra 180 days from the expiration date. You don’t need to take action. View your referrals and/or authorizations.

Questions? Contact your regional contractor. If overseas, contact your regional call center

Last Updated 9/3/2019