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Referral Process

TRICARE Prime Beneficiaries

Prime beneficiaries need a referral from their PCM before seeing a specialist outside the MTF. Without a referral, you may be billed under the Point-of-Service option at significantly higher out-of-pocket cost.

Do I Need a Referral?

Your TRICARE Plan
Referral Required?
Prime (Active Duty)
Yes — for ALL care outside the MTF
Prime (Family Members)
Yes — for specialty care outside the MTF
Select
No (except ABA)
TRICARE For Life
No
TRICARE Reserve Select
No
TRICARE Young Adult
No
 

Exceptions (No Referral Needed for Prime Family Members, Network):

  • Preventive care
  • Outpatient mental health (therapy, medication management, telehealth)
  • Emergency care

How the Referral Process Works: 5 Steps

Step 1: See Your PCM

Your Primary Care Manager evaluates your needs and determines if specialty care is required.

Step 2: PCM Submits Referral

If approved, your PCM's office submits the referral electronically.

Step 3: TriWest Processes the Referral

TriWest checks if WACH can provide the service first (MTF Optimization). If not, they authorize a network provider.

Step 4: You Receive Authorization

You will be notified of your approved provider and appointment details via text, email, or letter from TriWest.

Step 5: Attend Your Appointment

Bring your military ID and referral authorization number.


Referral Timelines

Referrals are processed per published TriWest and DHA access-to-care standards. Urgent referrals are expedited.

How to Check Your Referral Status

Emergency Care: No Referral Needed

If you have a medical emergency, seek care immediately at the nearest ER. No referral is required.
  • Call 911 for life-threatening emergencies
  • Notify TriWest within 24-72 hours if admitted to a civilian hospital
  • Follow up with your PCM after discharge

Mental Health Services

No referral needed for routine outpatient mental health (therapy, medication management, telehealth) in-network.
Pre-authorization required for:
  • Inpatient care (non-emergency)
  • Intensive Outpatient Programs (IOP)
  • Partial Hospitalization Programs (PHP)
  • Applied Behavior Analysis (ABA)
  • TMS, ECT, Spravato
  • Residential Treatment Centers

Key Contacts

Need
Contact
Number
Referral questions/status
TriWest
1-888-TRIWEST (1-888-874-9378)
Schedule PCM visit
WACH Appointment Line
866-957-9224
After-hours health question
Nurse Advice Line
800-TRICARE (874-2273), Opt 1

 

Managing Your Referral – Where to Go

On-Post Referrals (Fort Irwin/WACH)

Wait 3 business days after your PCM appointment, then call the appropriate clinic:

Clinic/Service

Phone Number

Army Wellness Center (Bldg. 127) – No referral needed

760-380-7375

Dental – Shuttleworth Clinic

760-380-3166

Behavioral Health (3rd Floor, WACH)

760-383-5440

General Surgery

760-383-5305 / 760-380-5377

Immunizations

M/T/W/F 0800–1100 & 1300–1500; 2nd/4th Thurs 0800–1145

Internal Medicine

866-957-9224 (Central Appt Line)

Flight Medicine

760-383-5207 / 5238 (Fax: 760-383-5127)

OB/GYN

760-383-5355

Optometry

866-957-9224 or 760-383-5333

Orthopedics / Physical Therapy

760-383-5370

Primary Care (Blue & Gold Teams)

760-383-5200

Nutrition Care

760-383-5501

Audiology

760-383-5812

SUDCC (Substance Use Disorder Clinical Care)

760-380-4074

Note: Self-referrals require a completed DA Form 8003 with your supervisor’s signature.
 

Referrals to Other Military Treatment Facilities (MTFs)

(Balboa Naval Medical Center / Camp Pendleton)

  • Wait 3 business days after your appointment.
  • The MTF will contact you directly to schedule.
  • If you don’t hear back in 5 business days, call 1-888-TRIWEST 
  • Direct Lines:
    • Balboa Referral Desk: 619-532-8225
    • Camp Pendleton Referral Desk: 760-719-3222

Referrals to Civilian Providers

(Barstow, Apple Valley, Victorville, etc.)

  • Processing can take 3–5 business days.
  • Check status online at the TriWest Portal or call 1-888-TRIWEST.
  • Create an account at the TRICARE West website to view or your referral or change your servicing provider.
  • You must schedule the appointment yourself. Civilian clinics may or may not contact you.
  • If you want to change your provider, only TRICARE can assist: 1-888-TRIWEST.
  • Do not ask your PCM to submit a new referral if there’s a problem—contact Triwest for help.
  • Off-post clinics should fax appointment notes to WACH Medical Records at 760-383-5142.\

Changing Your Referral Service Provider:

  1. Access the TriWest Portal: Log in at https://tricare.triwest.com/en/beneficiary/.
  2. Navigate to "Authorizations."
  3. Locate Authorization.
  4. Request a Change: Look for "Change Provider" or similar.
  5. Select a New Provider: Choose a new in-network provider.
  6. Submit Your Request.
  7. Check Status: Allow processing time and check the status through the portal.
  8. Important: A new referral may be required. Follow TriWest's instructions.
  9. For step-by-step instructions, visit: https://tricare.triwest.com/globalassets/tricare/beneficiary/TRICARE-West-Region-Change-Servicing-Provider-QRG.pdf
  10. Unable to Change Online? Contact TRICARE at 1-888-TRIWEST. WACH Referral Management cannot modify authorizations.

Important Reminder: When scheduling, always confirm the specialist is a TRICARE network provider. Out-of-network care without authorization results in Point of Service charges.

Contact Us

Phone

Appointment Line

866-957-9224 (WACH)

TRICARE Enrollments & Referrals

TriWest Portal or Call 1-888-TRIWEST

Don't forget to keep your family's information up to date in DEERS!