Tip for Contractor-specific

TRICARE Prime requires referrals for specialty care — TRICARE Select does not

Tip for Contractor-specific

If self-referring without authorization under Prime, you may be responsible for the full cost

Tip for Contractor-specific

Always confirm the referred provider accepts TRICARE before scheduling

Military / TRICAREmoderateDoctor signature required

TRICARE Referral / Pre-Authorization Request

Contractor-specific · TRICARE managed care contractors

Referral or prior authorization for specialty care, certain procedures, and medications under TRICARE Prime. Not required for TRICARE Select.

Form Details

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Where to Submit This Form

🌐

Submitted by your Primary Care Manager (PCM) through the TRICARE provider portal

Referrals are typically initiated by your PCM's office electronically.

🌐

Call your regional TRICARE contractor

https://tricare.mil/ContactUs

For TRICARE Prime: your PCM must submit the referral. For prior authorization, the provider or you can call.

📠

Fax to your TRICARE regional contractor

Fax numbers vary by region — check TRICARE.mil for your contractor's fax number.

Filing Deadline

Referrals: must be obtained before seeing a specialist (TRICARE Prime only). Prior authorization: must be approved before the service is rendered.

Required Attachments

📎 Referral request from the Primary Care Manager
📎 Clinical documentation supporting the need for specialty care or procedure
📎 Relevant test results, imaging, or diagnostic reports

Processing Time

Routine referrals: 1-5 business days. Urgent referrals: 24-72 hours. Prior authorization: 5-14 business days.

What Happens Next

You will receive a referral/authorization number. The referred provider must have this number to bill TRICARE. Referrals are typically valid for 90 days.

Tips for This Form

✓ TRICARE Prime requires referrals for specialty care — TRICARE Select does not
✓ If self-referring without authorization under Prime, you may be responsible for the full cost
✓ Always confirm the referred provider accepts TRICARE before scheduling
✓ For urgent/emergency care, you can get a retroactive referral within 24-72 hours

More Military / TRICARE Forms

TRICARE DoD/CHAMPUS Medical Claim

DD Form 2642 · Department of Defense

TRICARE medical claim form for beneficiaries seeking reimbursement when providers do not file claims directly. Must attach itemized bill on provider letterhead. Used by active duty, retirees, and family members.

TRICARE Enrollment (milConnect/DEERS)

Online enrollment · Defense Health Agency

Enrollment in TRICARE plan options (Prime, Select, etc.) through milConnect or DEERS update. Requires valid military ID.

DEERS Enrollment Application

DD Form 1172-2 · Department of Defense

Application for Department of Defense Common Access Card (CAC) or DEERS Enrollment. Establishes beneficiary status for TRICARE eligibility.

TRICARE Pharmacy Prior Authorization

Express Scripts PA form · Express Scripts (TRICARE pharmacy contractor)

Prior authorization for non-formulary medications or formulary drugs with utilization management requirements under TRICARE.

Post-Deployment Health Assessment

DD Form 2796 · Department of Defense

Post-Deployment Health Assessment completed by service members within 30 days of returning from deployment. Screens for deployment-related health concerns including mental health, environmental exposures, and injuries.

Post-Deployment Health Reassessment

DD Form 2900 · Department of Defense

Post-Deployment Health Reassessment completed 90-180 days after return from deployment. Follow-up screening for emerging health issues including PTSD, TBI, and other delayed-onset conditions.

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Disclaimer: BeneFill™ provides form-filling assistance and informational guidance only. It is not affiliated with, endorsed by, or sponsored by the TRICARE managed care contractors or any government agency. The information provided is for general informational purposes and does not constitute legal, medical, financial, or tax advice. Always verify form requirements and submission details directly with the issuing agency.