• An Important Message From TRICARE   (Española)  
  Issued to beneficiaries during a hospital inpatient stay to explain their rights/access to services.

• Case Management Behavior Health Referral Form  
  Used by a civilian or MTF provider to refer a beneficiary for behavioral case management evaluation.

• Case Management Medical Referral Form  
  Used by a civilian or MTF provider to refer a beneficiary for medical case management evaluation.

• EMC Attachment Form   
  Used by providers when additional documentation is required for an electronically submitted claim.

• Other Health Insurance Questionnaire  
  Used by beneficiaries to update their other health insurance information.

• Non-Covered Services Waiver Form   
  Used by providers to inform beneficiaries of particular services not covered by TRICARE.

• Patient Referral Authorization Form  
  Used by providers that do not have Internet service when requesting a referral or prior authorization for health care services. This method requires providers to print form, then fax to: 1-877-548-1547.

Preferred method is online submission:  Sign-In or Sign-Up

• PrecisionRx Specialty Solutions Fax Order Form   
  Used by providers to order injectable specialty drugs via fax.

• Reconsideration Coversheet/Tipsheet  
  The reconsideration request tipsheet is a tool to assist you in putting together your reconsideration documentation.

• Request for Additional PT/OT Services   
  Used by providers for requesting additional physical and occupational therapy.