FORT RILEY, Kansas –
The Defense Health Agency has temporarily waived the requirement for pre-authorization of outpatient specialty care referrals for TRICARE Prime enrollees in the West Region. This means specialty care providers can treat patients without waiting for TriWest referral approval.
What Does This Mean for You?
- You must still get a referral from your Primary Care Manager (PCM) before seeing a specialist.
- You do not need TriWest approval before seeking an outpatient specialist.
- This waiver applies only to outpatient care.
What Is Not Covered Under the Waiver?
The following services still require TriWest pre-authorization:
- Inpatient care
- Applied Behavior Analysis (ABA) or Autism Care Demonstration services
- Laboratory-developed tests
- Extended Care Health Option (ECHO) services
Steps to Follow
- Receive a Referral from Your PCM:
- Your referral will be processed by the Referral Management Team based on your home address or PCM’s recommendation.
- Obtain Your IACH TRICARE Provider Letter Referral Waiver:
- Available within 1 business day via the MHS GENESIS Patient Portal.
- Or, pick it up in person within 2 business days at the Referral Management or Benefits Counselor Offices on the first floor.
- Bring Your Waiver to the Specialist:
- Ensure the waiver includes effective dates, referral details, and provider information.
Important Notes
- The process for seeking specialty care within military hospitals or clinics has not changed.
- If IACH's specialist have the capability and capacity to provide requested care, you will be seen at IACH.
- If your network specialist is no longer a TRICARE network provider, you can still see them with TRICARE Prime copayments, as long as they are TRICARE-authorized.
- Patients must present their IACH TRICARE Waiver Provider Letter to network provider.
- This process will be in place through March 31 and is retroactive to January 1, 2025.
Contact Information
If you have any questions, please reach out:
- Referral Management Office: 785-239-3627(Option 4, Option 5)
- Benefits Counselor: 785-239-7968 or 785-240-7297
This temporary process ensures our patients can continue accessing specialty care without unnecessary delays. Thank you for your understanding and cooperation.