Referrals to Military Hospitals and Clinics
Health Net Federal Services, LLC (HNFS) will first attempt to coordinate care at a military hospital or clinic for TRICARE Prime beneficiaries who live near a military facility and are referred for care that requires an approval. Therefore, if the provider submits a request to HNFS, the beneficiary may be referred to the military hospital or clinic for care, regardless of whether a civilian network provider is requested. If the services are not available at the military hospital or clinic, the care will be coordinated with a civilian TRICARE network provider. This coordination of services is also known as the right of first refusal process.
If the TRICARE Prime beneficiary, excluding active duty service members, does not wish to receive his or her care from the military hospital or clinic, he or she can choose to use his or her Point of Service (POS) option or disenroll from TRICARE Prime.
Note: The POS option will only apply to those services that require an approval. For example, ancillary services will not incur POS charges if the beneficiary chooses to receive care from a civilian network provider.
TRICARE Select beneficiaries can self-refer to a TRICARE network or TRICARE-authorized non-network provider and do not have to obtain care at the military hospital or clinic. By using TRICARE network providers, TRICARE Select beneficiaries can save on their out-of-pocket costs.
How Does This Process Work?
When a provider submits a request to HNFS on behalf of a TRICARE Prime beneficiary, the request is forwarded to the military hospital or clinic to determine if the facility can provide the service(s).
If it is determined the military hospital or clinic can provide the service, HNFS will complete the request and the beneficiary will be advised to contact the MTF to schedule an appointment. If the military hospital or clinic is not able to provide the service, HNFS will complete the referral to a civilian network provider and notify the beneficiary so he or she can schedule the appointment.