District 20 Surgeon News

UPDATES TO TRICARE MANUALS ANNEX – December 2017

As of this afternoon (2 Jan 18), the DHA Front Office has made a final decision on urgent care referrals. As specified below, the decision to move forward with unlimited urgent care visits will be effective 15 Jan 18, but will be retroactive to 1 Jan 18. Recommend maintaining status quo until 15 Jan 18 in order to avoid complications.

Beginning Jan. 1, 2018, TRICARE Prime enrollees other than active duty service members (ADSM) no longer need a referral for urgent care visits, and point of services charges no longer apply for urgent care.

ADSMs and ADFMs enrolled in TRICARE Overseas Program (TOP) Prime/Prime Remote and seeking urgent care overseas must obtain an authorization from the TOP contractor to ensure their urgent care visit will be cashless and claimless. Without a prior authorization, overseas providers may request payment upfront and the beneficiary will then have to submit a claim for reimbursement. The contractor will process the claim with no point of service charge.

Similarly, ADFMs enrolled in Prime in the U.S. but traveling overseas must contact the TOP contractor to obtain an authorization to ensure their urgent care visit will be cashless and claimless. The contractor will process the claim with no point of service charge.

ADSMs enrolled in TOP Prime/Prime Remote who are TDY or on leave in the U.S. may access urgent care without a referral or authorization.

If you have questions, please contact me (at contact information bellow) or Maj Joseph Sanchez 703-681-7872 (DSN 761) or joseph.l.sanchez6.mil@mail.mil.

V/R
DAVID P. ABBOTT, Maj, USAF, MSC, FACHE
Director, Access to Care Program
Office of the Air Force Surgeon General (AFMSA/SG3S)
7700 Arlington Blvd, STE 5158,
Falls Church, VA 22042-5158
Cubicle: 4NW348B
Comm: (703) 681-7866 DSN: (312) 761-7866
Email: david.p.abbott2.mil@mail.mil

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