Referral Management Center
Obtaining a Referral
To obtain or renew a referral you must contact your primary care management team. If you have other questions about referrals, you should contact TriWest Healthcare Alliance at
TRICARE West or call 888-874-9378.
Referral Waiver Guidelines for Patients of the 75th Medical Group
On Jan. 23, 2025, the Defense Health Agency began a temporary waiver of outpatient referral requirements for eligible TRICARE West Region beneficiaries enrolled in a TRICARE Prime plan. This temporary waiver allows TRICARE Prime patients to seek outpatient TRICARE-covered services that would otherwise require approval from TriWest Healthcare Alliance, including those referrals submitted to TriWest on or after Jan. 1, 2025.
The waiver is effective for referrals and orders for service issued to TRICARE Prime beneficiaries Jan. 1, 2025, through March 31, 2025, and valid for services rendered through June 30, 2025. The waiver applies to all TRICARE Prime beneficiaries in the West Region, including active duty service members, active duty family members, retirees, and their families. Patients who are enrolled in TRICARE Select or TRICARE For Life don’t need a referral to see a specialist.
After receiving a referral for outpatient specialty care, beneficiaries can seek care from any TRICARE-authorized specialty provider (network or non-network) without waiting for TriWest's referral pre-authorization. All network providers have been notified they can provide care without a pre-authorized primary care manager referral and will be reimbursed for the TRICARE-covered services they deliver. This temporary measure helps ensure faster access to specialty care while TriWest resolves system issues. The process for getting specialty care within a military hospital or clinic has not changed.
Exceptions
The waiver doesn’t apply to:
- MTFs or providers in the Humana East Region
- Referrals for which care can be provided within the MTF/Direct Care System
- Inpatient Care
- Applied Behavioral Analysis/Autism Care Demonstration Services
- Laboratory Developed Tests
- Extended Care Health Option Services
- NATO/Foreign Affiliates/Line of Duty Individuals
- Other Non-TRICARE Prime Beneficiaries
- Non-Covered Benefits
- Other Services Requiring Pre-authorization or Medical Necessity Reviews
Patients should seek guidance from the 75th Medical Group Referral Management Center, located on the second floor of the clinic, if any of the exceptions listed above apply to them.
How to Seek Referred Specialty Care During the Waiver Period
Since referrals won’t be sent to TriWest for authorization and assignment to a network provider, the 75th Medical Group’s Referral Management Center must manually process referrals. Patients must use the TriWest Provider Directory to select a TRICARE authorized specialist. For patients’ convenience, after your PCM refers you for outpatient specialty care, you may either take steps in-person to receive your referral or request your referral be sent to a provider of your choosing over the phone.
Note for all referrals created between Jan. 27 and March 31, 2025: Referral status won’t be visible to patients in the TriWest Beneficiary Portal and TRICARE network providers can’t view referrals in the Provider Portal.
In-Person Option
After your primary care visit with your PCM, visit our Referral Management Center, located on the second floor of the 75th Medical Group. Make two right turns after exiting the elevator or stairwell; the RMC is the second door on the left.
RMC will provide you with:
- A copy of your referral
- A copy of the TriWest Referral Waiver Letter
- Use the TriWest Provider Directory to find a TRICARE authorized provider for the specialty to which you have been referred.
- Call the provider’s office of your choice to verify they are TRICARE authorized and make an appointment.
- Bring your hard-copy referral and referral waiver to your appointment.
Telephone Option
After the primary care visit with your PCM, use the TriWest Provider Directory to find a TRICARE-authorized provider for the specialty to which you have been referred.
Call the provider’s office to:
- Verify they are TRICARE authorized
- Obtain accurate fax information for the office
- Call the 75th MDG’s RMC: 801-777-5414
- Provide RMC with the provider/facility name and the office’s fax number
- RMC staff will fax your documents directly to the provider you chose
- Call the provider’s office to verify they received your referral and schedule your appointment
Contact Information
- 75th MDG Referral Management Center: 801-777-5414
- 75th MDG TRICARE Health Benefits Advisor: 801-777-6670
- 75th MDG TRICARE Operations and Patient Administration Flight Commander: 801-777-7036
- 75th MDG TRICARE Operations and Patient Administration Flight Chief: 801-777-6721
- TriWest Customer Service: 888-874-9378
TriWest’s Customer Service Line is currently experiencing high call volumes resulting in hold times of hours to reach a customer service representative. Patients should first call the RMC for questions about referrals and the Health Benefits Advisor, TOPA Flight Commander, or TOPA Flight Chief for questions or concerns regarding TriWest or TRICARE benefits.
Important Reminder to Avoid Point of Service Fees
During this waiver period, beneficiaries may be seen by any TRICARE-authorized provider, whether network or non-network. However, starting April 1, 2025, TRICARE Prime enrollees must use a TRICARE network provider. Prime enrollees who see a non-network provider after March 31, 2025, without authorization will incur point-of-service fees.
West Region Transition General Information
The Defense Health Agency Director, Lt. Gen. Telita Crosland, has written a letter to West Region beneficiaries detailing concerns and corrective actions taken by DHA during the West Region contractor transition.
Do you have questions about referrals, authorizations, or other parts of the West Region transition? Check out TRICARE West Region Transition to learn who to contact with your questions.
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