![]() ![]() If you see a specialist without a referral, you’re using the point-of-service option.Įnrolled in TRICARE Prime Remote? Work with your regional contractor if you don't have an assigned PCM. Yes, for specialty care and some diagnostic services. TRICARE Prime (all beneficiaries except active duty service members) You also need a fitness-for-duty review for certain care. If you get care without a referral, you’ll pay out-of-pocket.Įnrolled overseas? Call your regional call center. Your PCM works with your regional contractor for the referral. Yes, for any care your PCM doesn't provide (urgent, routine, preventive, and specialty care) TRICARE Prime (active duty service member) ![]() Learn more about the differences between a referral and pre-authorization below: What plan are you using? You must get care under the authorization before it expires, or you’ll need to get the care re-approved. ![]() Contact your regional contractor if you need to find another provider. Schedule your appointment with the provider listed in the authorization letter.You'll need to check your region's secure patient portal. Referral authorization information isn't available on the MHS GENESIS Patient Portal. If you're registered on the MHS GENESIS Patient Portal, you won't see the status of your referral.If you have a question about your referral, use TOL Secure Messaging to contact your care team.If you're registered on the TOL Patient Portal, you can view your referral details by:.You can view status of referrals, authorizations, and claims using the M圜are Overseas mobile app or web-based portal.You can view authorization status, determination letters, and make network-to-network provider changes on the TRICARE West secure patient portal.You can view authorization status, provider, and services authorized on the secure Beneficiary Self-Service portal.You’ll need to create an account if you don’t have one. You can also check the status of your pre-authorization online. You can also view these instructions on your secure patient portal. Your regional contractor sends you an authorization letter with specific instructions. If you have a referral, then your provider gets pre-authorization at the same time. Getting pre-authorization means you’re getting the care approved by your regional contractor before you go to an appointment and get the care. For remotely located Active Duty and Reserve Component service members, the Military Medical Support Office (MMSO) at Defense Health Agency (DHA) - Great Lakes gives pre-authorization for civilian medical care. Note: Active duty service members need a referral for urgent care treatment. If you’re an active duty service member enrolled in TRICARE Prime, your PCM works with your regional contractor for the referral. A referral is when your primary care manager (PCM) or provider sends you to another provider for care that he/she doesn’t provide. ![]()
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