Referral Process
TRICARE Prime beneficiaries generally need a referral from their Primary Care Manager before receiving specialty care outside the military treatment facility. Without a required referral, you may be responsible for significantly higher out-of-pocket costs under the Point-of-Service option.
Do I Need a Referral?
Referral requirements depend on your TRICARE plan and the type of care you need. TRICARE Prime beneficiaries generally need a referral before receiving specialty care outside the military treatment facility.
Referral requirements by TRICARE plan
| TRICARE Plan |
Referral Required? |
| TRICARE Prime — Active Duty |
Yes — for care outside the military treatment facility unless otherwise authorized. |
| TRICARE Prime — Family Members |
Yes — for specialty care outside the military treatment facility. |
| TRICARE Select |
Generally no, except for certain services such as Applied Behavior Analysis. |
| TRICARE For Life |
Generally no. |
| TRICARE Reserve Select |
Generally no. |
| TRICARE Young Adult |
Requirements depend on whether you are enrolled in the Prime or Select option. |
Prime Family Member Exceptions
Prime family members generally do not need a PCM referral for the following services when using an authorized network provider:
- Preventive care
- Routine outpatient mental health care
- Emergency care
Important: Receiving specialty care without a required referral may result in Point-of-Service charges and significantly higher out-of-pocket costs.
How the Referral Process Works
- See Your PCM. Your Primary Care Manager evaluates your medical needs and determines whether specialty care is required.
- Your PCM Submits the Referral. If specialty care is medically necessary, your PCM's office submits the referral electronically.
- TriWest Processes the Referral. TriWest checks whether WACH or another military treatment facility can provide the service before authorizing a civilian network provider.
- You Receive Authorization. TriWest may notify you by text message, email, letter, or through the beneficiary portal. Review the assigned provider, approved service, number of visits, and expiration date.
- Attend Your Appointment. Bring your military ID card and referral authorization information to the appointment.
Referral timing: Referrals are processed according to published TriWest and DHA access-to-care standards. Urgent referrals are expedited based on medical need.
How to Check Your Referral Status
Call TriWest
Call for referral status, authorization questions, network provider information, or help managing an approved referral.
1-888-874-9378
Schedule a PCM Visit
Contact WACH when you need an appointment with your PCM to discuss a possible referral.
866-957-9224
Emergency Care: No Referral Needed
Do not delay emergency care. Call 911 or go to the nearest emergency room when you believe your life, limb, vision, or long-term health may be at risk.
- No referral is required for emergency care.
- Call 911 for life-threatening emergencies.
- Notify TriWest according to current requirements if you are admitted to a civilian hospital.
- Follow up with your PCM after discharge.
- Active duty service members should also notify their chain of command when appropriate.
For urgent but non-life-threatening symptoms, call the TRICARE Nurse Advice Line at 800-874-2273.
Mental Health Services
Routine outpatient mental health care, including therapy, medication management, and telehealth, may be accessed through authorized network providers without a PCM referral.
Services That May Require Preauthorization
- Non-emergency inpatient care
- Intensive Outpatient Programs
- Partial Hospitalization Programs
- Applied Behavior Analysis
- Transcranial Magnetic Stimulation
- Electroconvulsive Therapy
- Spravato treatment
- Residential Treatment Centers
- Substance use residential treatment
Emergency inpatient mental health or substance use care should not be delayed while seeking authorization. Follow TRICARE notification requirements after emergency admission.
Managing On-Post Referrals
For referrals to a WACH or Fort Irwin clinic, wait approximately three business days after your PCM appointment before contacting the clinic to schedule.
Self-referrals: A completed DA Form 8003 with the supervisor's signature may be required. Confirm current requirements with the receiving clinic.
Referrals to Other Military Treatment Facilities
Referrals may be directed to another military treatment facility, including Naval Medical Center San Diego or Camp Pendleton, when the required specialty is not available at WACH.
- Wait approximately three business days. Allow time for referral processing after your PCM appointment.
- Watch for contact from the receiving facility. The military treatment facility may contact you directly to schedule.
- Follow up if you are not contacted. If you have not heard from the receiving facility within five business days,
contact TriWest at 1-888-874-9378.
The receiving military treatment facility controls appointment availability and scheduling after the referral is accepted.
Referrals to Civilian Providers
When specialty care is not available at WACH or another appropriate military treatment facility, TriWest may authorize care with a civilian network provider.
What to Expect
- Processing may take approximately three to five business days.
- Check the referral through the TriWest Beneficiary Portal or call 1-888-874-9378.
- Review the assigned provider, authorized service, number of approved visits, and authorization expiration date.
- You are generally responsible for scheduling the appointment with the civilian clinic.
- Some civilian clinics may contact you, but do not assume they will.
- Confirm the provider is participating in the TRICARE network before receiving care.
Do not ask your PCM to submit a duplicate referral because of a scheduling or provider problem. Contact TriWest for assistance with the existing authorization.
After Your Civilian Appointment
Ask the civilian clinic to send appointment notes, test results, and treatment recommendations to WACH Medical Records.
Changing Your Referral Service Provider
If you need a different civilian provider, request the change through TriWest. WACH Referral Management cannot modify a TriWest authorization.
- Access the TriWest portal. Go to the TRICARE West beneficiary website and sign in.
- Open the authorizations section. Locate the referral or authorization you want to manage.
- Look for the provider-change option. Select the available option to change the servicing provider.
- Choose a new network provider. Review the available authorized providers and select the appropriate option.
- Submit the request. Allow time for processing and check the portal for an updated authorization.
Important: TriWest may determine that a new referral or additional action is required. Follow the instructions provided with your authorization.
For detailed instructions, review the TRICARE West Region Change Servicing Provider Quick Reference Guide .
If you cannot make the change online, call TriWest at 1-888-874-9378 (1-888-TRIWEST).
Always confirm network status before scheduling. Receiving care from an out-of-network provider without proper authorization may result in Point-of-Service charges and significantly higher out-of-pocket costs.
Referral Reminders
- Do not receive non-emergency specialty care until the required authorization is approved.
- Review the approved provider, service, number of visits, and expiration date.
- Confirm the specialist is in the TRICARE network.
- Schedule civilian appointments directly with the approved clinic.
- Contact TriWest when you need to change a provider or resolve an authorization issue.
- Ask off-post providers to send records back to WACH.
- Seek emergency care immediately when needed; no referral is required.
Referral information: Requirements, provider assignments, and processing procedures may change. Confirm current authorization details through TriWest before receiving care.