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

Active Duty Service Members (ADSM)

A Primary Care Manager (PCM) located at a military hospital or clinic (MTF), will refer you internally for services he/she cannot provide. If the military hospital or clinic cannot provide the services, they will work with Humana Military to issue a referral or authorization to seek care from a civilian network provider. Urgent care at the military hospital or clinic does not require a referral. Emergency care through an ER for a true emergency does not require a referral. Most care not provided by your PCM will require a referral. Please note: if you receive care for services that require a referral without obtaining one, you may be responsible for all or part of the bill.

TRICARE Prime

TRICARE Prime requires referrals for specialist office visits and some diagnostic services (if you receive services that require a referral without obtaining one, you are using your Point of Service (POS) option). Your PCM works with Humana Military for the referral and authorization. Prime enrollees may receive clinical preventive services from any network provider without a 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.

Prime beneficiaries must have a referral for clinical preventive services when they see a non-network provider.

TRICARE Prime Remote (TPR)

An assigned civilian PCM works with Humana Military to issue a referral or authorization for all services they are unable to perform. Urgent care does not require a referral if you see a TRICARE-authorized provider (network or non-network). Emergency care through an ER for a true emergency does not require a referral. Most care not provided by your PCM will require a referral. Please note: If you receive care for services that require a referral without obtaining one, you may be responsible for all or part of the bill.

TRICARE Select and all other beneficiaries

A referral is not required for services. Certain services (e.g., Applied Behavior Analysis (ABA), 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.

How do I get a referral?

Contact your PCM for a referral. 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).