TRICARE provider accessing beneficiary

Referrals and authorizations

Beneficiary self-service allows you to view or research information on an existing referral or authorization. You can see all of the details of your existing referrals by logging into beneficiary self-service. Please note that processing your referral may take up to two days once your provider submits it.

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Do I need a referral?

Whether or not you need a referral depends on who you are and what TRICARE plan you are enrolled in.

Active Duty Service Members

A referral from your Primary Care Manager (PCM) is required for any care he or she doesn’t provide, including urgent, routine, preventive or specialty care. Your PCM works with Humana Military for the referral and authorization to visit a military hospital or clinic. If a military hospital or clinic is not available, you will be referred to a network provider.

With the exception of emergency care through an ER, if you receive care without a referral from your PCM, you may be responsible for all or part of the bill.

 All others enrolled in a TRICARE Prime plan

TRICARE Prime requires referrals for specialist office visits and some diagnostic services*. Your PCM works with Humana Military for the referral and authorization. Prime enrollees may receive clinical preventive services from any network provider without referral or authorization. Urgent care visits do not require referrals. Certain services (e.g., inpatient admissions, some behavioral health services, adjunctive dental care, home health services, etc.) require prior authorization.

*If you receive services that require a referral without obtaining one, you are using your Point of Service (POS) option.

TRICARE Select  and all other beneficiaries

A referral is not required except for Applied Behavior Analysis. Certain services (e.g., inpatient admissions, some behavioral health services, adjunctive dental care, home health services, etc.) require prior authorization. You can get care from any TRICARE-authorized provider, network or non-network.

US Family Health Plan (USFHP)

If you participate in USFHP, please call, (800) 74-USFHP or (800) 748-7347 for information regarding your plan.

Prime Prime Remote Select TYA-Select TYA Prime TRS TRR TFL TYA-Prime Remote
PCM refers you to specialists for care he or she can't provide X X X X
Provider files claims for you
*network providers file claims for you
X X X*
X*
X X*
X*
X X
Referral required for most services X X X X
Require prior authorization for some services** X X X X X X X X
You may get care from any TRICARE-authorized provider, network or non-network without a referral X X X X


**Learn more about services that require prior authorization

How do I get a referral?

Contact your PCM for a referral for services outside their office. A specialist that you have an approved referral to see can also submit referrals for care related to their specialty. i.e. a neurologist can request a referral for an MRI of the brain.

How do I check the status of a referral?

You can see all of the details of your existing referrals by logging into beneficiary self-service. For the most timely and updated electronic information on referrals, authorizations or any other account features, be sure to log in to self-service to enter/confirm your email address. Log in now