TRICARE Referral Process: Requirements & Status Guide
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## Quick answer The TRICARE referral process is the method by which your Primary Care Manager (PCM) requests specialized care that they cannot provide themselves. If you are enrolled in a TRICARE Prime plan, you almost always need an approved referral before seeing a specialist to avoid significant out-of-pocket "Point-of-Service" charges.
Details
In the TRICARE system, a **referral** is for a specific medical specialty (like cardiology), while an **authorization** is for a specific procedure or expensive treatment (like a surgery or MRI).
### How the Process Works 1. **The PCM Visit:** You visit your PCM for an initial evaluation. If they determine you need specialized care, they submit a referral request to your regional contractor (**Humana Military** in the East or **TriWest Healthcare Alliance** in the West). 2. **Contractor Review:** The regional contractor reviews the request for medical necessity and checks if the care can be provided at a Military Medical Treatment Facility (MTF). 3. **The Notification:** You are notified via the contractor's secure portal (or by mail) once the referral is approved. This usually takes 2–5 business days for routine requests. 4. **Scheduling:** Once approved, you contact the specialist listed on the referral to set an appointment.
### Referral Requirements by Plan * **TRICARE Prime (and Select/Remote):** Referrals are **mandatory** for all specialty care. If you see a specialist without one, you will be charged under the **Point-of-Service (POS)** option. For 2026, POS charges typically include a $300 deductible for individuals and 50% of the TRICARE-allowable charge. * **TRICARE Select:** Most specialty care does **not** require a referral. You can manage your own specialized care, though some high-cost services still require pre-authorization. * **Active Duty Service Members (ADSMs):** You must have a referral for *all* care received outside of a military clinic, including urgent care.
### Mental Health Exception For most TRICARE beneficiaries (excluding active duty), referrals are not required for outpatient medically necessary mental health visits with a TRICARE-authorized provider. This is a common "edge case" intended to increase access to care.
### Checking Status You can track your referral status online through your regional contractor's portal: * **East Region:** HumanaMilitary.com * **West Region:** TriWest.com (Managed under the T-5 contract as of 2025/2026).
## Who this affects * **Active Duty Service Members:** Highest level of restriction; referrals required for everything. * **Active Duty Family Members (Prime):** Referral required for all specialty care. * **Retirees and Families (Prime):** Referral required for all specialty care. * **TRICARE Select Users:** Generally exempt from the referral process but subject to authorizations for specific procedures. * **Guard/Reserve:** Depends on whether they are on active duty orders or using TRICARE Reserve Select (which functions like Select).
## Sources * **TRICARE.mil:** [Referrals and Pre-Authorizations](https://www.tricare.mil/referrals) * **Humana Military (East):** [Manage Authorizations](https://www.humanamilitary.com) * **TriWest Healthcare Alliance (West):** [Provider Referrals](https://www.triwest.com) * **TRICARE.mil:** [Point-of-Service Option](https://tricare.mil/Costs/HealthPlanCosts/Prime/POS)