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.

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 check the status of a referral? 

You can access your referral letters by logging into your self-service account. When you view a referral that has been processed, you will find a link to view your referral letter. It could take 24-48 hours for a referral to show once a doctor has submitted it.

The ROFR process gives the military hospital or clinic the right to provide specialty care to a Prime beneficiary when available.

Important information about ROFR

• ROFR is a requirement under the Prime plan
  
• Only applies to Prime beneficiaries living within a 60 minute drive of a military hospital or clinic or who have waived their access to care standards to remain enrolled in Prime
• During Open Season, Prime beneficiaries can change to the Select plan where ROFR is not a requirement
• When care is received at a military hospital or clinic, there is no copay
• If a referral is accepted by the military hospital or clinic under ROFR, Humana Military cannot change the referral, only the military hospital or clinic can approve it to be changed to a civilian provider
• ROFR can only be reversed and care released to a civilian provider for continuity of care or for special circumstances that prevent the beneficiary from being able to utilize a military hospital or clinic

After it is determined a beneficiary needs to be referred for specialty care, the requesting provider will submit a referral/authorization request via web or fax to Humana Military for approval and ROFR processing.

Many times the military hospital or clinic will have the specialized services available. In this scenario, the military hospital or clinic will notify us, usually within one business day and the beneficiary will be referred to that facility.

The facility may contact the beneficiary to schedule an appointment and Humana Military will provide the beneficiary with the information for that health facility. If the facility cannot provide the services or care requested, the patient will be referred to a civilian network provider. However, it is important to understand if a provider is selected prior to the ROFR determination and the military hospital or clinic can provide the services and accepts the care, this overrides any prior provider selection, requiring the beneficiary to be seen at the military facility.