If you are enrolled in TRICARE Prime you must first contact your primary care manager (PCM). If you cannot get care from your PCM, he or she must submit a referral to Health Net for civilian urgent care services. TRICARE Standard beneficiaries do not require a referral. Learn more on our emergent and urgent care page and referral and authorization requirements.
Learn more about the differences on our Prior Authorizations and Referrals page.
TRICARE requires a provider, typically your primary care manager or family doctor, to submit prior authorization and referral requests. TRICARE Standard beneficiaries can self-refer. Please contact your provider and have him or her submit your request.
If you are a TRICARE Prime beneficiary living near a military treatment facility (MTF) and are referred for specialty care, inpatient admissions, or procedures requiring approval, Health Net will first attempt to coordinate your care at the MTF. If the services are not available at the MTF, the care will be coordinated with a TRICARE network provider.
Visit our Referrals to MTFs page for additional information.
It's important to prepare for your next doctor's appointment so you can get the most out of your time with him or her. We have created some appointment tips which include a checklist of the things you might want to ask your doctor and the things that are important for him or her to know.
Any denied authorization can be appealed. However, the following cannot be appealed:
Learn how to file an appeal on our Appeals page.
Active duty service members who have other health insurance (OHI) require an approval from Health Net for all services. All other beneficiaries with OHI only require a prior authorization for inpatient behavioral health services. Beneficiaries with OHI need to follow their OHI rules for obtaining care even if those services are not covered by OHI or benefits have been exhausted.
Visit our How TRICARE Works with OHI page to learn more.
An approval from Health Net is not required for breast pumps or supplies, as long as the breast pump obtained matches the type of pump included on your prescription from a TRICARE network or non-network physician, physician assistant, nurse practitioner, or nurse midwife.
Using a network provider will prevent you from having to pay for services up front and filing claims for reimbursement later. View our breast pumps and supplies directory to find a network provider.
View TRICARE’s Breast Pump and Supplies benefit page for more information on what’s covered.