How to get a referral in TRICARE?

Getting a referral in TRICARE Prime involves coordinating with your primary care manager (PCM) to access specialty care. Schedule an appointment with your PCM or contact their office to discuss your symptoms and the need for specialist evaluation. Your PCM will assess your condition, determine if specialty care is medically necessary, and submit the referral electronically through the TRICARE system. The referral specifies the type of specialist, the number of authorized visits, and the timeframe for the referral (typically 90 days). Once submitted, you should receive confirmation from your regional contractor, and you can then schedule an appointment with the approved specialist. Check your referral status through your regional contractor's website, the MHS GENESIS patient portal, or by calling the contractor's customer service line. Some services do not require referrals even under Prime, including preventive care, mental health care (first eight outpatient visits per year), eye exams for diabetics, and emergency or urgent care. If your PCM is unavailable, you can contact your MTF or regional contractor for assistance with urgent referral needs. Keep in mind that TRICARE Select does not require referrals for any services.