Referral

A referral is formal authorization from your Primary Care Manager (PCM) for you to receive specialty care or certain services. Referrals are a key component of the TRICARE Prime managed care system and help ensure coordinated, medically necessary care.

When referrals are required: • TRICARE Prime: Required for most specialty care • TRICARE Select: Not required (you can self-refer) • Active Duty: Always required except for emergencies

What referrals authorize: • Visits to specialist providers • Diagnostic tests and imaging • Certain therapies and treatments • Number of approved visits • Timeframe for care

How referrals work: 1. Visit your PCM for evaluation 2. PCM determines specialist care is needed 3. PCM submits referral to TRICARE 4. You receive referral authorization 5. Schedule appointment with approved specialist 6. Specialist provides care within referral scope

Important notes • Referrals typically expire after a set time or number of visits • Some referrals include prior authorization for procedures • Emergency care never requires a referral • Self-referrals outside the system may not be covered

Referral management: • Track referrals through your online portal • Confirm referral is active before specialty appointments • Request extensions if more visits are needed • Keep PCM informed of specialty care outcomes

The referral system ensures your PCM stays informed about all your healthcare and helps prevent unnecessary or duplicate services, ultimately controlling costs while maintaining quality care.