Frequently Asked Questions About TRICARE Select®
Monday, November 6, 2023
Soon, TRICARE beneficiaries will be reviewing health plan choices for the coming year. TRICARE Open Season runs Nov. 13-Dec. 12, 2023, and offers those who are eligible for TRICARE Prime and TRICARE Select the opportunity to make enrollment changes effective Jan. 1, 2024. As providers, it’s important to understand the plan options offered to TRICARE patients. The following Q&A covers frequently asked questions about TRICARE Select, a self-managed, preferred provider organization (PPO) plan for eligible non-active duty service members. TRICARE Select may be the right choice for those who live in an area where they can’t use TRICARE Prime, have other health insurance, or want to see a non-network TRICARE-authorized provider.
How do I verify patient eligibility and TRICARE plan enrollment?
- Online using our Eligibility & Deductible Tool (login required).
- Through self-service prompts at 1-844-866-WEST (9378).
- Via a 271 electronic data interchange (EDI) request.
Learn more about ways to check eligibility through our self-paced online course, Checking TRICARE Eligibility in the TRICARE West Region.
How do patients get care?
With TRICARE Select, beneficiaries can see any TRICARE-authorized provider for covered services.
Are there out-of-pocket costs?
Beneficiaries may pay a deductible and copays or cost-shares based on the services received. They can save costs by seeing TRICARE network providers. TRICARE Select costs also depend on the sponsor’s military status. Refer to our Benefits and Copays and Copayment and Cost-Share Information pages for details.
Are referrals required for specialty care?
Beneficiaries using TRICARE Select do not have primary care managers. Referrals are not required for most primary and specialty appointments. However, some services may require pre-authorization. Check pre-authorization requirements using our Prior Authorization, Referral & Benefit tool.
How do I submit a pre-authorization or check authorization status?
Submit pre-authorizations and check authorization statuses online using our Submit an Authorization or Authorization Status tools (login required).
How do I find more information regarding reimbursement or claims-related questions or issues?
Take advantage of our website’s secure tools to check claim status (login required), or review helpful reimbursement information with our billing tips pages.
If a patient has other health insurance (OHI), how does that work with TRICARE Select?
As with all TRICARE plans, non-active duty service members who have OHI must use their OHI before TRICARE. Pre-authorization is only required for applied behavior analysis services. Visit our Claims page for more information.