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Tricare Kills Urgent Care Referral Requirement for Some Users

An ambulance sits outside the 366th Medical Group urgent care center at Mountain Home Air Force Base, Idaho, Feb. 19, 2015. (U.S. Air Force/Airman Connor J Marth)
An ambulance sits outside the 366th Medical Group urgent care center at Mountain Home Air Force Base, Idaho, Feb. 19, 2015. (U.S. Air Force/Airman Connor J Marth)

Tricare Prime users can now make unlimited visits to in-network urgent care facilities without a referral, officials recently announced.

Previously, active duty family members as well as retirees and their families enrolled in Tricare Prime users were able to make two urgent care visits per year without first receiving a referral under a pilot program ordered by Congress and started in May 2016.

The new policy applies to all Prime users except active-duty troops, officials said.

"Effective January 1, 2018, a referral for urgent care visits for Tricare Prime enrollees, other than active duty service members, is no longer required and point of service charges no longer apply for such claims," Tricare officials announced on their Facebook page. "This supersedes the previous policy in the Tricare manuals, which currently waives referrals for only the first two urgent care visits per year for Prime enrollees other than active duty service members."

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A proposed Tricare policy published in the Federal Register last year said "the specific number of urgent care visits without a referral will be determined annually prior to the beginning of the open season enrollment period."

That rule means the referral requirement could be reinstated for 2019, a Tricare spokesman confirmed Thursday. That decision would be made prior to Tricare's new annual open season enrollment period, which starts Nov. 18.

In 2016, Congress ordered Tricare to allow Prime users to make urgent care visits "without the need for preauthorization for such services."

But a Tricare spokesman late last year denied that order requires them to allow unlimited visits without a referral. He said that's because "preauthorization" and "referral" are different processes. A "preauthorization" must be processed before an appointment, and a "referral," can be processed after the visit occurs, he said.

-- Amy Bushatz can be reached at amy.bushatz@military.com.

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