Referrals and Authorization: Military Facility First Consideration

Military facility first consideration lets the military hospital or clinic provide specialty careSpecialized medical/surgical diagnosis, treatment, or services a primary care provider isn’t qualified to provide. to those who have TRICARE Prime.

What Should I Know About This Process? 

• It only applies if you have TRICARE Prime.
• You must live within a 60-minute drive of a military hospital or clinic; you can also waive the drive-time standards to stay enrolled in TRICARE Prime.
• During TRICARE Open Season, you can switch to TRICARE Select; this plan doesn’t require military facility first consideration.
• There is no copaymentA fixed dollar amount you may pay for a covered health care service or drug. for care received at a military hospital or clinic.
• TRICARE East can’t change the facility that accepts a referral; only the military hospital or clinic can do that.

You can do a reversal for the following reasons:

• Continuity of care
• Special circumstances that prevent you from using a military hospital or clinic

How Does the Process Work?

A provider will submit a referral request to us if they say you need specialty care. Often, the military hospital or clinic has the specialized services available. In that case, they’ll notify us. This is usually within one business day. Then, we will refer you to that military hospital or clinic.

The facility may contact you to schedule an appointment. Then, we will give you the details about that facility. If they can’t provide the services, you’ll be referred to a civilian network provider.

If you choose a provider before the military facility first consideration decision, and the military facility can provide the services, you must go to the military facility.