Is Approval Needed?

On Feb. 20, 2018, the Defense Health Agency implemented a temporary waiver of outpatient referral and authorization requirements for TRICARE West Region beneficiaries enrolled in a TRICARE Prime plan.

  • Please review our TRICARE Prime Referral Waiver page for details and guidelines on how to access care during the waiver period.

  • The Prior Authorization, Referral and Benefit Tool below may be used to verify TRICARE-covered services, but the referral and authorization guidelines displayed for TRICARE Prime beneficiaries may not apply during the waiver period.                                     

Prior Authorization, Referral and Benefit Tool

The Prior Authorization, Referral and Benefit Tool allows you to easily determine:

  • approval requirements from Health Net Federal Services, LLC (HNFS)
  • benefit limitations and
  • how to locate applicable copayments or cost-shares.

This tool only identifies whether a HNFS approval is needed. It does not provide the approval. If it is determined that an approval is needed, please follow up with your provider so he/she can submit the request for review.