Beneficiaries should know how to choose or change their TRICARE provider

| August 28, 2018 | 0 Comments
TRICARE
News Release

Whether you’re looking to change your primary care manager (PCM) or find a specialty care provider, you have options with TRICARE. With directories at your fingertips, you can take command of your health and your TRICARE benefit.

TRICARE Prime: Getting Your PCM

When you enroll in TRICARE Prime, you either choose or get assigned a PCM who will manage all of your routine, non-emergency, and urgent health care. You may choose a military or network provider as your PCM, depending on your location and availability. In most cases, when you live near a military hospital or clinic, you’ll be required to have a PCM at that facility. If you don’t list a PCM on your enrollment form, TRICARE will choose one for you. Active duty service members (ADSMs) will be assigned a PCM at their military hospital or clinic.

TRICARE logo

TRICARE logo

TRICARE Prime Remote ADSMs and family members will be assigned a TRICARE network provider to serve as their PCM when available. If no network providers are available, then you may choose a TRICARE-authorized non-network provider. You’ll see that provider for most of your care and must seek a referral for specialty care.

You can use the TRICARE East Region and TRICARE West Region online directories to find a provider. Call first to confirm the provider is accepting new patients. Remember that your PCM will refer you to a specialist for specialty care.

TRICARE Overseas Program (TOP) Prime: Getting Your PCM

When you enroll in TOP Prime, you’re assigned a PCM and get most of your care from that PCM at a military hospital or clinic, or in the TRICARE civilian provider network. If you don’t have an assigned PCM, your TOP Regional Call Center will coordinate your care.

If you’re enrolled in TOP Prime Remote and don’t have an assigned PCM, then International SOS Government Services, Inc. will assist you with your health care needs. Referrals and prior authorizations are required for certain services.

TRICARE Prime: Changing Your PCM

If you already have a PCM, depending on the capacity of your military hospital, you may choose a new PCM. This may not apply to ADSMs because duty station and military unit affects PCM assignments. All other beneficiaries should check to make sure the PCM you choose is accepting new patients. If choosing a civilian PCM is an option for you, or you wish to change to another PCM at your military hospital, there are three ways to submit your change.

1. By Phone

2. Online

  • Go to the Beneficiary Web Enrollment website. (Not available overseas).
  • Click on the red “Log On” button at the top of the page.
  • Lastly, click on the “Change Primary Care Manager” button in the Actions Menu.

3. By Mail

  • Print, fill out, and mail a TRICARE Prime Enrollment, Disenrollment and PCM Change Form to your regional contractor with the new PCM’s name and address (mailing address is found on the form).
  • You only need to complete the part of the form related to the PCM change.
  • Find the forms on the TRICARE East, TRICARE West, and TRICARE Overseas websites. For USFHP, select the form for your USFHP provider.

The change is effective the date you submit the change, or a date you specify up to 90 days in the future.

TRICARE Select: Finding a Provider

TRICARE Select enrollees can seek care from any TRICARE-authorized providerAn authorized provider is any individual, institution/organization, or supplier that is licensed by a state, accredited by national organization, or meets other standards of the medical community, and is certified to provide benefits under TRICARE. There are two types of TRICARE-authorized providers: Network and Non-Network.. You may choose any TRICARE-authorized provider as a primary care provider. You’ll make your own specialty appointments without a referral, but will have lower out-of-pocket costs with TRICARE network providers. Use the search directory to find providers who accept TRICARE.

TOP Select enrollees may also choose from any TRICARE-authorized network provider. Some care may require a referral, so you must coordinate care with your TRICARE overseas contractor. To find a provider near you, use the overseas Provider Search tool. To confirm the type of provider listed in the provider directory, contact your TOP Regional Call Center. Press option 6 to speak with a member of the TOP Select Customer Service Team.

Use these TRICARE resources to make finding or changing providers simpler for you and your family. And check out the TRICARE website for more help on finding a provider or changing a primary care manager.

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Category: Health

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