Creating referrals and authorizations
All referrals and authorizations must be submitted through provider self-service.
All referrals and authorizations will move to electronic submissions through provider self-service by the end of 2023.
When completing a referral, always include the sponsor's TRICARE ID, diagnosis and clinical data explaining the reason for the referral.
If the patient needs services beyond the referral’s evaluation and treatment scope, the PCM must approve additional services.
All network PCM and specialist-to-specialist referral requests will be directed to system-selected providers or to providers the beneficiary has seen in the preceding six months.
- The choice of up to five providers will reflect the optimal options in terms of quality of care, accessibility (e.g., appointment availability), affordability and drive time from the beneficiary’s address.
- If the beneficiary resides within a military hospital’s catchment area (40-mile radius), the services requested may be subject to redirection to that military hospital through the Right of First Refusal (ROFR) process.