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Specialty Care Referrals

  • Published
  • By TRICARE.mil Staff
  • Communications Division, Defense Health Agency
Many TRICARE Prime beneficiaries receive primary care from providers in military medical hospital and clinics. Occasionally, they may need to receive specialty care. When this happens, they must receive a referral from their primary care manager (PCM).

Getting a referral makes sure your regional or overseas contractor authorizes the care before you make an appointment. If the care is available at a military hospital or clinic near you, and there is space available, you will be referred there first. Military hospitals and clinics have 90 minutes to accept urgent referrals and two business days to accept referrals for routine care. If your local military hospital or clinic does not accept the referral within that time, you will be referred to a network provider near you.

Your regional contractor will send a letter with the name and location of your specialty provider. The letter will also tell you what care is authorized, the length of time you are authorized to receive that care, and the type and number of visits you are allowed before you need another referral.

Before making an appointment with the specialty care provider, call your regional contractor 3-5 days after the PCM enters the referral to check the status. Try to take copies of your medical records, x-rays and lab results with you to see the specialist.

If you are overseas and are referred to a host nation provider, be sure to coordinate your care through your overseas contractor.