TRICARE Suspends Pre-Authorization Requirement for Specialty Care Referrals for West Region

FALLS CHURCH, Virginia – The Defense Health Agency today announced TRICARE Prime enrollees in the West Region may see TRICARE-authorized specialty providers for outpatient care without getting primary care manager (PCM) referrals pre-authorized by TriWest Healthcare Alliance. However, enrollees still need their PCMs to provide referrals before getting specialty care.

This process will be in place through March 31 and is retroactive to Jan. 1.
DHA is committed to ensuring enrollees maintain timely access to safe, high-quality specialty care.

TRICARE Prime enrollees may seek outpatient care from any TRICARE-authorized specialty provider with the following documentation:
• A copy of the referral dated Jan. 1-March 31, or a copy of an unexpired referral authorized before Jan. 1 by Humana Military or Health Net Federal Services, LLC.
• A copy of the TRICARE West Region Referral/Authorization Waiver Approval Letter, available on tricare.mil/west.

TRICARE Prime enrollees may see both network and non-network TRICARE-authorized providers during this waiver period. TRICARE Prime enrollees should ask the provider if they’re TRICARE-authorized.

This waiver does not apply to:
• Inpatient care
• Applied behavior analysis or Autism Care Demonstration services
• Laboratory developed tests
• Extended Care Health Option services

If enrollees need any of these services, TriWest will still need to approve their referral before they see a specialist.

For more information, please visit the TRICARE Newsroom, or tricare.mil/west.