New Urgent Care Pilot Program for Prime Beneficiaries
/ Published July 27, 2016
To increase access to care, the Department of Defense launched an Urgent Care Pilot Program for TRICARE Prime beneficiaries.
This program allows Prime enrollees two visits to a network or TRICARE authorized provider without a referral or prior authorization.
The Urgent Care Pilot Program is for:
• 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. are not limited to two visits.
Active-duty service members enrolled in TRICARE Prime are not eligible for this program as their care is managed by their service. This pilot also excludes Uniformed Services Family Health Plan enrollees.
TRICARE Overseas Program enrollees can receive an unlimited number of urgent care visits, but only when they are traveling stateside and seeking 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 primary care manager 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.
When you are not sure of the type of care you need, or you require care outside of standard business hours, call the Nurse Advice Line at 1-800-874-2273. If the Nurse Advice Line recommends an urgent care visit and a referral is submitted, that visit will not count against the two pre-authorized visits allowed under the Urgent Care Pilot. However, if you call the Nurse Advice Line and get a referral to a military hospital or clinic and you go elsewhere for care, that visit will count against your two preauthorized visits.
If you need more information, please visit http://www.tricare.mil/UrgentCarePilot.