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20 May 6, 2016 Desert Lightning News
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New urgent care pilot program for Prime beneficiaries
TRICARE.mil Staff
Communications Division, Defense Health Agency
FALLS CHURCH, Va. (AFNS) -- To increase access to care, the Defense gent care visits, but network copayments still apply.
Department is launching an Urgent Care Pilot Program for TRICARE Prime Once an individual receives urgent care, they must notify their primary
beneficiaries. This program allows Prime enrollees two visits to a network
or TRICARE-authorized provider without a referral or prior authorization. care manager about that care within 24 hours or the first business day af-
ter the urgent care visit. Authorization requirements have not changed for
The Urgent Care Pilot Program, scheduled to begin May 23, is for: follow-up care, specialty care or inpatient care.
- Active-duty service members (ADSMs) (including National Guard or
Reserve members activated -- called or ordered to active-duty service -- for Those who are not sure of the type of care they need, or who require care
more than 30 consecutive days) in TRICARE Prime Remote. outside of standard business hours, should call the Nurse Advice Line (NAL).
- Non-ADSMs in TRICARE Prime, TRICARE Prime Remote or TRI- If the NAL recommends an urgent care visit, and a referral is submitted, that
CARE Young Adult Prime. visit will not count against the two pre-authorized visits allowed under the
- TRICARE Overseas Program beneficiaries traveling in the U.S. (not lim- Urgent Care Pilot Program. However, if an individual calls the NAL and
ited to two visits). gets a referral to a military hospital or clinic and they go elsewhere for
Active-duty service members enrolled in TRICARE Prime are not eligible care, that visit will count against the two preauthorized visits.
for this program as their care is managed by their service. This pilot also
excludes Uniformed Services Family Health Plan (USFHP) enrollees. TRI-
CARE Overseas Program (TOP) 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 ur-
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