TRICARE Prime access standards ensure that TRICARE Prime beneficiaries get the care they need close to home and in a timely manner. All TRICARE network and military treatment facility providers are
expected to follow these guidelines:

• Emergency services must be made available to TRICARE Prime beneficiaries 24 hours a day, seven days a week.
   
• Maximum appointment wait times should not exceed:
  • One day for acute illnesses
     
  • One day for an initial urgent appointment with a behavioral health care provider
     
  • One week for a routine appointment
     
  • One week for the initial routine appointment with a behavioral health care provider
     
  • Four weeks for a wellness visit
     
  • Four weeks or less for specialty care appointments (wait time based on nature of care required; patient’s primary care manger determines level of urgency)
     
  • Thirty minutes or less for office waiting times for nonemergency appointments (if you are unable to adhere to this policy, notify the patient and offer to reschedule)

If you or someone in your practice is a patient’s assigned primary care manager and a patient who does not require emergency care calls after hours, please follow these guidelines:

• Put the patient in contact with an “on call” TRICARE network physician who is covering for you
  or your practice
   
• Offer self-care advice
   
• Offer a next-day appointment, if appropriate
   
• Direct the patient to a TRICARE participating urgent care center

For more information on TRICARE’s access standards, refer to Section 2 of your TRICARE Provider Handbook.

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