Making sure our beneficiaries have quick access to quality care is one of TRICARE Prime’s top priorities.

To ensure medically-necessary care is available when TRICARE Prime beneficiaries need it, the Department of Defense (DoD) has put in place standards for timely access to civilian care. As a primary care manager (PCM), it is up to you to uphold these standards when providing care to TRICARE beneficiaries.

Appointment Wait Time Standards

With a wide array of specialists available to provide care to TRICARE Prime beneficiaries, referrals from you to other health care
providers can be handled rapidly. TRICARE Prime beneficiaries must receive an urgent care appointment within 24 hours (one day); the wait for a routine appointment will not exceed one week (seven days); and specialty care appointments and wellness visits must be available within four weeks (28 days).

When a TRICARE Prime beneficiary arrives at your office, he or she should be seen by the provider within 30 minutes or less in a nonemergency situation. If your anticipated appointment schedule is interrupted because you are providing emergency care to
another patient, your staff should notify waiting and arriving patients of the cause and length of the anticipated delay. They should offer patients the choice to either reschedule, or wait and keep their original appointment.

Drive Time Standards

The TRICARE Network has a sufficient number of PCMs accepting new patients in Prime Service Areas. Because of this, TRICARE Prime beneficiaries can drive from their homes to their PCM—at either a military treatment facility or in the TRICARE Network—in less than 30 minutes under normal circumstances.

For specialty care appointments, the beneficiary’s travel time to a TRICARE Network provider should be less than one hour.

If you are a primary care manager and you are accepting new patients, remember that TRICARE Prime beneficiaries are entitled to a drive time of less than 30 minutes under normal circumstances from their homes to your office. If you need to refer your patient for specialty care services, the beneficiary’s drive time should be less than one hour.

Verifying the Standard

As a TRICARE Network provider, meeting these standards is essential. If you have any change in demographics, panel status or your ability to meet appointment standards, you must notify Humana Military within 10 days of the change.

  
Back to Top

Created: May  23, 2007