TRICARE Prime Travel Benefit for Specialty Care
Tuesday, September 15, 2020
The TRICARE Prime Travel Benefit offers reimbursement to certain beneficiaries enrolled in TRICARE Prime or TRICARE Prime Remote who are referred to specialists 100 or more miles away. In order to qualify, there must be supporting clinical documentation confirming specialty care within 100 miles was not available.
How it works
TRICARE patients referred for non-emergent, medically necessary specialty care over 100 miles (one way) from their primary care manager’s (PCM’s) office, may be eligible to receive reimbursement for reasonable travel expenses under TRICARE’s Prime Travel Benefit.
Active duty family members, retired service members and their families, Medal of Honor veterans and their families, and any other non-active duty beneficiaries may qualify for this benefit if they:
- Are enrolled in TRICARE Prime or TRICARE Prime Remote at the time of travel,
- Have a valid PCM referral/authorization for specialty care, and
- Have confirmed there are no other network, non-network, or military hospital or clinic providers within 100 miles from their PCM who meet their treatment needs.
Prior to sending TRICARE Prime patients to a specialty provider more than 100 miles away, you must first verify there is not a suitable provider within 100 miles that can treat the patient. The referral or clinical documentation submitted with your request must indicate why a closer provider could not meet the patient’s needs. Keep in mind, patient/provider preference is not a valid reason.
We encourage you to use our online network directory to help you locate local specialty providers for your TRICARE patients.
Find more information about the Prime Travel Benefit at www.tricare.mil/primetravel.