TRICARE Referrals and Specialty Care

  • Published
  • By Tyler Patterson
  • TriWest Healthcare Alliance
Has your primary care manager (PCM) decided that you need to see a specialist? Getting the care you need is just four simple steps away:

1. Get a referral
If you are a TRICARE™ Prime beneficiary who needs specialty medical care, you'll need to get your PCM to submit a referral request. If you use TRICARE for Life, TRICARE Standard/Extra, TRICARE Reserve Select or TRICARE Retired Reserve, you don't need a referral to see a specialist, although you may need a prior authorization for some services. Contact TriWest at 1-888-TRIWEST (874-9378) to find out.

2. Wait for your authorization letter to arrive
Good news: you can shave a few days from the process in this step! Register for paperless authorization letters at www.triwest.com/Paperless and you will receive your authorization letter electronically within 24 hours of TriWest authorizing your referral. If you aren't registered, you'll receive your letter in the mail about a week after your referral is authorized.

3. Set your appointment
You can either schedule an appointment with the specialist you were referred to, or you can use the Provider Directory at www.triwest.com/ProviderDirectory to find another TRICARE network provider. Remember to call TriWest and let us know who your new provider will be if you use the Provider Directory to find a different specialist.

4. Notify TriWest at 1-866-876-2383
To help manage your care, it's important that your PCM receives the consultation or treatment records from your specialist quickly. We can help if you let us know when your appointment is scheduled. Have your appointment date, tracking number and Sponsor's Social Security Number ready. Don't forget to let us know if your appointment date changes.

That's all there is to it! The only thing you'll need to do after letting TriWest know your appointment date is to go to your appointment.

Want to make things even more convenient? While you're signing up for electronic authorization letters at www.triwest.com/Paperless, don't forget to check out our other online features like paperless claims, paperless explanation of benefits statements, online enrollment fee payments and more!