The Military Health System is committed to providing TRICARE Prime beneficiaries with timely access to providers within specific time frames and certain drive times from their homes. We ask for your commitment to these access standards.

Appointment Wait Time

TRICARE policy requires network providers to meet the following access standards for appointments for beneficiaries enrolled in TRICARE Prime:
 

Patient wait times in nonemergency situations must not exceed 30 minutes, except when you are providing emergency care to other patients and the normal schedule is interrupted. You should notify patients of the cause for the delay and the length of delay anticipated, and then offer to reschedule the appointment. Patients may choose to stay and keep their scheduled appointment.

Primary care managers (PCMs) accepting new patients should understand beneficiaries are entitled to a drive time that does not exceed 30 minutes from their home to your office under normal circumstances.

When helping patients with referrals to specialists, PCMs should also be aware in most cases TRICARE Prime beneficiaries do not have to travel more than an hour from their home to access specialty care. TRICARE Prime beneficiaries residing outside of a Prime Service Area (a geographic area where TRICARE Prime is offered) have waived their drive time standards and are required to use network PCMs and specialists regardless of distance.

Meeting TRICARE Prime access standards is essential for network providers. Network providers must notify Humana Military within 10 days of any change to demographics, panel status or ability to meet appointment standards.

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Last Reviewed:  February 1, 2007