JOINT BASE LANGLEY-EUSTIS, Va. –
To increase access to care, the Department of Defense launched an Urgent Care Pilot Program for most TRICARE Prime beneficiaries on May 23, 2016.
The program now allows most Prime enrollees two visits to a network or TRICARE authorized provider without a referral or prior authorization.
The following beneficiaries are eligible Urgent Care Pilot Program:
· Active duty service members, including National Guard or Reserve members activated for more than 30 consecutive days, in TRICARE Prime Remote
· Non-Active Duty Service members in TRICARE Prime, TRICARE Prime Remote or TRICARE Young Adult Prime
· TRICARE Overseas Program beneficiaries traveling in the U.S.
Active Duty Service members enrolled in TRICARE Prime are not eligible for this program as their care is managed by their Service. The program also excludes Uniformed Services Family Health Plan enrollees.
TRICARE Overseas Program enrollees can receive an unlimited number of urgent care visits, but only when seeking stateside care.
There are no Point of Service deductibles or cost shares for these two urgent care visits, but network copayments still apply.
Once you receive urgent care, you must notify your PCM about that care within 24 hours or the first business day after the urgent care visit. Authorization requirements have not changed for follow up care, specialty care, or inpatient care.
If unsure, patients can contact the Nurse Advice Line at 1-800-TRICARE and choose option 1 to find TRICARE approved clinics or receive information after duty hours.
If the NAL recommends an urgent care visit and a referral is submitted to a nonmilitary clinic, that visit will not count against the two pre-authorized visits allowed under the Urgent Care Pilot; however, this does not apply if the NAL refers a military hospital or clinic and the patient receives care from a nonmilitary clinic.
For more information, visit
http://www.tricare.mil/urgentcarepilot.