Many TRICARE members may confuse referral with authorization. A referral is when your primary care manager (PCM) or provider sends you to another provider for care. You may also need pre-approval, or prior authorization, for coverage of certain care. Prior authorization is a review of a requested health care service by your regional contractor to see if TRICARE will cover it. Under the new rules for TRICARE Prime, your PCM may refer you to a network specialist without approval from your regional contractor. Also, active duty servicemembers (ADSMs) must get referrals for civilian care, which includes mental health care, specialty care and more. ADSMs also need prior authorizations for all inpatient and outpatient specialty services. Under TRICARE Prime and TRICARE Select, certain services need prior authorization. For more information, visit the Referrals and Authorization webpage on the TRICARE website.
For complete overviews on TRICARE benefits, visit the Military.com TRICARE Overview.