There may be times when a TRICARE beneficiary from a different TRICARE region will come to you
for treatment or when you may have to advise one of your own TRICARE beneficiaries about how to access care while traveling. TRICARE offers several program options with varying requirements for out-of-area care, and it is important to be aware of the requirements for each option.

           
Emergency Care

For emergency care, TRICARE beneficiaries should go directly to the nearest emergency room or call 911 for assistance. A referral or authorization is not required.
 
If a hospital admission occurs, a TRICARE Prime, TRICARE Prime Remote (TPR) or TRICARE Prime
Remote for Active Duty Family Members (TPRADFM) beneficiary should contact his or her primary care manager (PCM) or regional contractor within 24 hours or the next business day. If not admitted, the beneficiary must still coordinate any follow-up care with his or her PCM. TPR active duty service members (ADSMs) and TPRADFM beneficiaries without PCMs should contact their regional contractor to coordinate follow-up care. TRICARE Standard beneficiaries should also follow up with their primary care physician or family doctor.

       
Urgent Care

If the need for urgent care arises (e.g., a sprain or sore throat), a TRICARE Prime, TPR or TPRADFM beneficiary must obtain a referral from his or her military treatment facility (MTF), PCM or regional contractor before visiting a civilian provider. Without a referral, urgent care is covered under the TRICARE point of service (POS) option (except for ADSMs), resulting in higher out-of-pocket costs for beneficiaries. TPRADFM beneficiaries must always obtain an authorization from the regional contractor before seeking urgent care from non-network providers.
 
Note: The POS option does not apply to TRICARE Prime or TPRADFM beneficiaries if they have other health insurance that provides primary coverage. TRICARE Standard beneficiaries do not require a referral for urgent care. Authorization is not required for overseas-enrolled active duty family members seeking care in the United States, except for nonemergency inpatient behavioral health care.

       
Routine Care

TRICARE beneficiaries should seek routine care from their MTF or network PCMs. Obtaining care from their MTF or network PCMs will result in the lowest out-of-pocket costs.

       
Claims

Regardless of the type of care provided, out-of-area TRICARE beneficiaries other than ADSMs must pay applicable copayments and cost-shares. You should submit all reports and claims information to the region where the beneficiary is enrolled, or where the beneficiary resides if not enrolled, not the region where care was received. If you have any questions about submitting claims for out-of-area TRICARE beneficiaries, contact the appropriate TRICARE regional contractor listed below.
 
North Region—Health Net Federal Services, LLC, 1-877-TRICARE (1-877-874-2273).
Includes Connecticut, Delaware, the District of Columbia, Illinois, Indiana, Kentucky, Maine, Maryland, Massachusetts, Michigan, New Hampshire, New Jersey, New York, North Carolina, Ohio, Pennsylvania, Rhode Island, Vermont, Virginia, West Virginia, Wisconsin and portions of Iowa (Rock Island Arsenal area), Missouri (St. Louis area) and Tennessee (Fort Campbell area).
 
West Region—TriWest Healthcare Alliance Corp., 1-888-TRIWEST (1-888-874-9378).
Includes Alaska, Arizona, California, Colorado, Hawaii, Idaho, Iowa (excluding the Rock Island Arsenal area), Kansas, Minnesota, Missouri (excluding the St. Louis area), Montana, Nebraska, Nevada, New Mexico, North Dakota, Oregon, South Dakota, Texas (the southwestern corner only, including El Paso), Utah, Washington and Wyoming.
 
Overseas—Wisconsin Physicians Service.
Processes all claims for beneficiaries residing in any of these TRICARE overseas areas—TRICARE Europe, TRICARE Latin America and Canada, TRICARE Pacific or Puerto Rico (except ADSMs) and the U.S. Virgin Islands. Refer to Chapter 8 of the TRICARE Provider Handbook for the appropriate number to call based on beneficiary overseas residence.
 
For more information on treating out-of-area TRICARE beneficiaries, see Chapters 7 and 8 of the TRICARE Provider Handbook.

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