What procedures must beneficiaries follow for referrals within TRICARE Prime?

Beneficiaries enrolled in TRICARE Prime must get a referral from their Primary Care Manager (PCM) to see a specialist. This process ensures that care is coordinated and that patients receive the most appropriate and necessary treatment based on their individual health needs. The PCM assesses the patient's condition and, if specialist care is deemed necessary, provides a referral that facilitates access to more specialized services.

This requirement is in place to streamline care and avoid unnecessary procedures, ensuring that specialists are used effectively. By obtaining a referral, patients benefit from a structured approach to their healthcare, which can lead to better outcomes and more informed decisions about their treatment options. The referral process is essential for maintaining the integrity of the TRICARE Prime program and helps manage costs while providing high-quality care.