Primary Care Managers (PCM)

PCMs coordinate all care for their patients and provide non-emergency care whenever possible. PCMs also maintain patient medical records and refer patients for specialty care that they cannot provide. When required, PCMs work with Humana Military to obtain referrals and prior authorizations. Learn more about referral and authorization requirements

PCMs can be a part of military hospitals or clinics or civilian TRICARE network providers. The following provider specialties may serve as a TRICARE PCM:

  • Family practitioner
  • General practitioner
  • Internal medicine physician
  • Nurse practitioner
  • Physician assistant
  • Pediatrician
  • Obstetricians and gynecologist (Gender restrictions apply)

TRICARE Prime beneficiaries agree to initially seek all non-emergency services from their PCM. PCMs are specified providers selected to provide primary care services at the time of enrollment. The PCM is an individual provider within a military or civilian setting.

PCM’s roles and responsibilities:

  • Primary care services are typically, although not exclusively, provided by internal medicine physicians, family practitioners, pediatricians, general practitioners and, nurse practitioners
  • When a provider signs a contractual agreement to become a PCM, he or she must follow TRICARE procedures and requirements for obtaining specialty referrals and prior authorizations for non-emergency inpatient and certain outpatient services
  • In the event the assigned PCM cannot provide the full range of primary care functions necessary, the PCM must ensure access to the necessary healthcare services, as well as any specialty requirements
  • PCMs are required to provide access to care 24 hours a day, seven days a week, including after-hours and urgent care services, or arrange for on-call coverage by another provider

Note: The on-call provider must be an authorized network provider who is also a PCM. The PCM or on-call provider will determine the level of care needed:

  • Routine care: The PCM or on-call provider instructs the TRICARE Prime beneficiary to contact the PCM’s office on the next business day for an appointment
  • Urgent care: The PCM or on-call provider coordinates timely care for the TRICARE Prime beneficiary
  • The on-call physician should contact the PCM within 24 hours of an inpatient admission to ensure continuity of care
  • PCMs referring patients for specialty care may need to coordinate the referral with Humana Military
  • ADSMs must have referrals for all care outside of military hospitals and clinics (except for emergencies or as provided in TPR regulations, if applicable), including all behavioral healthcare services. If the ADSM has an assigned civilian PCM under TRICARE Prime or TPR, all specialty referral and authorization guidelines must be followed