Urgent Care Pilot Program begins May 23

Published May 31, 2016
21st Medical Group

PETERSON AIR FORCE BASE Colo. - -- Are you enrolled in TRICARE Prime, TRICARE Prime Remote or TRICARE Young Adult-Prime? If so, accessing urgent care just got easier. TRICARE is conducting an Urgent Care Pilot Program, which started May 23 and will run through May 23, 2019. This program allows TRICARE Prime beneficiaries (excluding Active Duty) up to two urgent primary care visits without a referral or prior authorization. There are no point of service deductibles or cost shares for these two urgent care visits, but network copayments still apply.

Common Questions:

Do you advise calling the Nurse Advice Line prior to visiting a TRICARE approved urgent care clinic?

- Yes. To ensure that your Primary Care Manager team receives a copy of your urgent care note and to avoid any erroneous point-of-service fees, it is highly recommended that ALL TRICARE Prime beneficiaries contact the NAL at 719-524-2273, option 3, prior to seeking care. If you get a pre-authorization from the NAL for urgent care, it will not count against your two visit limit.

What happens after I meet the two visit limit in a fiscal year?

- After you meet the two visit limit each fiscal year (1 Oct. – 30 Sept.), you must have a referral from your PCM for any urgent care needs your PCM cannot provide. Without a referral, you will be using the point-of-service option and may incur a bill.

- To avoid point-of-service fees, contact your PCM to get a referral or authorization prior to seeking urgent care or call the NAL at 719-524-2273, option 3, 24 hours a day, 7 days a week. If the registered nurse recommends urgent care, the NAL can provide you with a pre-authorization for care and this visit will not count against your two visit limit.

Can Active Duty members go to an urgent care clinic without a referral?

- No, Active Duty members enrolled to TRICARE Prime are not eligible.

- Likewise, Activated Guard/Reserved enrolled in TRICARE Prime are not eligible.

Remember after every urgent care visit, it is important to notify your PCM within 24 hours at 719-524-2273, option 1. Also, if the urgent care clinic recommends you see a specialist for follow-up care, contact your PCM for a referral before seeing the specialist. Otherwise you risk paying out-of-pocket costs associated with point-of-service care.

If you have any questions or need additional information about the TRICARE Urgent Care Pilot Program, visit www.tricare.mil or call the 21st Medical Group’s TRICARE Operations and Patient Administration Office at 1-719-556-1014.