Referrals & Enrollment Guide

This guide provides essential information for TRICARE beneficiaries receiving care at or through Weed Army Community Hospital (WACH). It covers referrals, enrollment, changing PCMs, and accessing helpful resources.

Getting Started with a Referral

• Your Primary Care Manager (PCM) will initiate a referral through the MHS GENESIS system when specialty care is needed.
• Want to see a specific provider or clinic? Let your PCM know at the time of your appointment.
• Active Duty Service Members: All referrals must be reviewed and approved by the Health Center Commander before processing.

Booking a Specialty Appointment

• You will not receive an authorization letter by mail.
• Check your authorization online at TRICARE West or by calling 1-888-TRIWEST.
• Only see the provider listed on your authorization. If you go out-of-network or don’t have authorization, you may be billed under the Point of Service option.

If the Specialist Recommends Additional Services

• Any extra tests, procedures, or follow-ups not listed on your referral must be approved separately.
• The specialist must submit the request to TRICARE.
• If services are available at WACH, care will be redirected here.
• Always check that your authorization is active and not expired before your appointment.
• TRICARE does not allow retroactive referrals.

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:

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 WACH Referral Management: 760-383-5483
• 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 Referral Management at 760-383-5483 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.

E. 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.
 

Prime Travel Reimbursement

• Only available when referred over 100 miles and services are not available locally.
• Reimbursement is not available if you choose to travel outside the area when care is available closer.
• Visit the Prime Travel webpage to get started.

TRICARE Enrollment & PCM Management

Enrollment & Eligibility

• You can only enroll or switch TRICARE plans during:
  • A Qualifying Life Event (QLE) – allows changes within 90 days
  • TRICARE Open Season (each fall)
• Learn more: https://tricare.mil/lifeevents

Assigning a Primary Care Manager (PCM)

• Assignment depends on:
  • Your home address
  • PCM availability
  • MTF guidelines & TRICARE access standards
• To enroll or change your PCM:
  • Call Health Net Federal Services: 844-866-9378
  • Or visit the Managed Care Division at WACH
  • Or use the Beneficiary Web Enrollment (BWE) tool under “Manage Health Benefits”

Newborn Enrollment

• Enroll your newborn in DEERS within 90 days (stateside).
• Failure to do so will result in loss of TRICARE eligibility after day 90.
• Ensure your child is also enrolled in TRICARE Prime through TriWest or the BWE portal.

Changing Your PCM

• Changes must be made in person at the Managed Care Division or by calling 760-383-5491
• Health Net cannot process PCM changes
• Not all requests are guaranteed—assignments depend on provider availability
• JVTMC Soldiers: Contact the Patient Advocate at 760-383-5099 for PCM changes unrelated to UIC assignments

Need to Check Your Current PCM?

• Go to: https://myaccess.dmdc.osd.mil (DS Logon required)
• Access the MHS GENESIS Patient Portal
• Select “View Patient Information/PCM” from the left menu
• Your PCM will be listed under Medical Contacts at the bottom
• To view dependents’ PCMs, use the drop-down menu at the top

Learn More:

• TRICARE Enrollment Details: https://tricare.mil/plans/enroll
• TRICARE Webinars: https://tricare.mil/Resources/MediaCenter/TRICARE-Webinars