TRICARE Access to Care Standards

Access to care standards impose limits on how long you have to wait to get health care appointments in the TRICARE network. Getting an appointment in a timely manner is important to you—and to us. Our goal is to ensure you get the right level of care, at the right time, by the right provider.

There are different ATC standards based on the type of care you need. The ATC standards below apply to all TRICARE plans except TRICARE For Life.

Type of Care	Access to Care Standards for TRICARE Network Providers
Emergency Care You can get emergency care at the nearest emergency roomThe hospital department that provides emergency services to patients who need immediate medical attention. or call 911 (or the Medical Assistance Number if overseas).	Immediate access Note: If you’re enrolled in a TRICARE Prime option, be sure to call your PCM or regional contactor within 24 hours or the next business day.
Urgent Care Urgent care is care needed for conditions such as a sprain, sore throat, or fever.	Within 24 hours (1 day) even if you’re traveling
Routine Care Routine (primary) care includes general office visits for the treatment of symptoms, chronic or acute illnesses and diseases, and follow-up care for an ongoing medical conditions.	Within 1 week (7 days)
Specialty CareSpecialized medical/surgical diagnosis, treatment, or services a primary care provider isn’t qualified to provide. Specialty care includes any care your PCM doesn’t provide for certain symptoms and conditions.	Within 4 weeks (28 days)
Preventive Care Preventive services are health screenings, tests, and examinations.	Within 4 weeks (28 days)

Note: If you’re enrolled in a TRICARE Prime option, the ATC standards timeframe starts from the date you get an approved referral.