TRICARE to begin Urgent Care pilot program

  • Published
HANSCOM AIR FORCE BASE, Mass. --  To increase access to care, the Department of Defense is launching 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, scheduled to begin this spring, is for:

·Active-duty family members enrolled in TRICARE Prime or TRICARE Prime Remote

·Retirees and their family members who are enrolled in Prime within the 50 United States or the District of Columbia

·Active duty service members enrolled in TRICARE Prime Remote and stationed overseas but traveling stateside

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, beneficiaries must notify their 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.

For those not sure of the type of care needed, or require care outside of standard business hours, are encouraged to call the Nurse Advice Line. If the NAL 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 an enrollee calls the NAL and receives a referral to a military hospital or clinic and choose to go elsewhere for care, that visit will count against the two preauthorized visits.

For further information, visit the Urgent Care Pilot Program web page on the TRICARE website at www.tricare.mil.

Beneficiaries may contact their Hanscom primary care manager by sending them a MiCare message, or by calling 781-225-6789 and leaving a message with their PCM team. Clinic officials will need the name of the TRICARE network facility visited and the date so that officials can obtain any medical records and ensure appropriate follow-up is scheduled.