How to get TRICARE authorization?

TRICARE pre-authorization (also called prior authorization) is a process where certain healthcare services must be approved by TRICARE before they are provided to ensure they are medically necessary and covered. Your healthcare provider typically handles the authorization process by submitting a request to your regional TRICARE contractor with clinical documentation supporting the medical necessity of the proposed service. Services commonly requiring pre-authorization include non-emergency inpatient hospital admissions, certain outpatient surgical procedures, durable medical equipment above specified cost thresholds, specialized treatments (bariatric surgery, transplants), some diagnostic tests and imaging studies, and residential treatment programs. The regional contractor reviews the request and responds with an approval, denial, or request for additional information, typically within 5 business days for non-urgent requests and 24 hours for urgent requests. If authorization is denied, the provider or beneficiary can appeal the decision. For TRICARE Prime, many authorizations are handled through the referral process from the PCM. Emergency services never require pre-authorization. Beneficiaries should confirm with their provider that any required authorizations are in place before receiving scheduled services to avoid unexpected costs or denials.