Using the Prior Authorization, Referral and Benefit Tool

If you are unsure how to answer a question in the Prior Authorization, Referral and Benefit Tool, use the following links for additional information: 

• Select the patient’s TRICARE Plan: Learn about TRICARE plans.
• Patient is an active duty service member (ADSM): If the patient is a spouse or dependent of an ADSM, a retired service member or a spouse or dependent of a retired service member, select "No."
• Patient has other health insurance (OHI) as primary coverage: How TRICARE works with OHI.
• Patient is dual eligible under both TRICARE and Medicare: Medicare (TRICARE For Life).
• Servicing Provider: Network versus non-network providers. 
• Care being provided by the primary care manager (PCM).
• Service Type: Outpatient versus Inpatient.

After answering the questions listed in the tool, the TRICARE prior authorization and/or referral requirements for that service will be provided.