TRICARE Access to Care Standards

Access to Care standards differ depending upon the TRICARE program assigned to each patient.

TRICARE Prime beneficiaries are entitled to the following access to care standards detailed in 32 CFR 199.17(p)(5)(ii):

1. Emergency Care: Beneficiaries seeking emergency care should proceed to the nearest emergency room or call 911 (or other local emergency assistance number) for immediate medical attention. In accordance with DoDD 6000.14, Military Health System (MHS) beneficiaries have the right to access emergency healthcare services when and where the need arises. Emergency services are covered in circumstances where acute symptoms are of sufficient severity that a "prudent layperson" could reasonably expect the absence of medical attention would result in serious health risks or death. Call your Primary Care Manager (PCM) or Southern Regional TRICARE Office at 1-800-444-5445 within 24 hours of your visit so a retroactive referral can be placed to ensure a bill is not generated to you for services.


2. Urgent Care: Beneficiaries should have an appointment to visit an appropriately trained provider within 24 hours and within 30 minutes travel time of the beneficiary's residence. If this appointment cannot be provided within these access standards at a military treatment facility (MTF), unlimited number of Urgent Care Center (UCC) visits are now available without the need for referral or authorization. Providers no longer need to write urgent care referrals for PRIME patients. Urgent care is defined as a non-emergency illness or injury for which you need medically necessary treatment. An urgent care condition will not result in further disability or death if not treated immediately; however, treatment should take place within 24 hours of illness or injury to avoid further complications and unnecessary suffering. Please go to the BJACH Emergency Room to receive Urgent Care services.


3. Open Access: If you require a Primary Care appointment, the access standard is the same day of your request. Whether you have an acute issue (i.e., cold symptoms) or need a wellness check (i.e., well woman’s exam, well child) the clinic will work to schedule you an appointment.


4. Established (Follow-up): Access standards do not apply to follow-up appointments as the provider determines the next visit.


5. Specialty and Wellness Services: If your provider requests a specialty appointment as a result of your visit, (i.e., surgery, obstetrics, behavioral health, etc.), the standard is 28 days. If the clinic is not able to meet these access standards, they will offer you a referral to a TRICARE civilian network provider. These standards also apply to our civilian TRICARE Prime enrolled beneficiaries with civilian network PCMs.

 

Beneficiaries not enrolled in TRICARE Prime will be seen on a space available basis.

Office Waiting Times: 32 CFR 199.17(p)(5)(ii) states that office waiting times in non-emergency circumstances shall not exceed 30 minutes, except when emergency care is being provided to patients and the normal office schedule is disrupted. If you have been waiting more than 30 minutes, please inform the front desk staff.