trained provider within 7 calendar days and within 30 minutes’ travel time of the beneficiary’s residence. All TRICARE Prime beneficiaries have access to a primary care provider representative by telephone around the clock.

SPECIALTY APPOINTMENTS

Following an initial behavioral health assessment, referrals for additional care are to be provided within the access standard for specialty care, which is 4 weeks (28 days), unless the referring provider determines that care is needed more urgently. Beneficiaries must be offered an appointment with an appropriately trained provider within 1 hour’s travel time from the beneficiary’s residence. Military treatment facilities have first priority for providing referred specialty care or inpatient care for behavioral health conditions for all TRICARE Prime beneficiaries.

PRIOR APPROVAL

Referral by a primary care provider is not required for family members and retirees for the first eight outpatient behavioral health visits.



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