TRICARE Referrals and Womack's Right of First Refusal | Fort Bragg | ProviderQuoHealth

Under TRICARE Prime, your primary care manager (PCM) coordinates your care. When you need specialty care that your PCM cannot provide, they submit a referral request to Humana Military (the TRICARE East contractor) for authorization and processing.

Once the referral is approved, you receive a notification through your beneficiary portal with information about the authorized provider and the timeline for scheduling. Specialty care appointments should generally be scheduled within 28 days of the referral being issued, according to DHA guidance.

Active-duty service members need a referral for virtually all care outside their assigned military clinic, including urgent, routine, and preventive care from providers other than their PCM. Other TRICARE Prime enrollees need referrals for specialty care and some diagnostic services.

In the Fort Bragg area, TRICARE Prime enrollees are subject to the Right of First Refusal. This means that when a specialty care referral is submitted, Womack Army Medical Center gets the first opportunity to provide that care before it is sent to a civilian network provider.

Here is the typical sequence: your PCM submits a referral request to Humana Military. The request goes to Womack, which reviews whether it can provide the needed specialty service. If Womack can accommodate you, your referral is directed there. If Womack cannot provide the service, the referral goes out to the civilian TRICARE East network.

This process applies only to TRICARE Prime enrollees. If you are enrolled in TRICARE Select, you are not subject to the Right of First Refusal, and you can book directly with a civilian network provider.

Once a referral is assigned to Womack Army Medical Center through the Right of First Refusal process, you generally cannot request to switch to a civilian provider unless there are specific continuity-of-care or access circumstances. Womack makes the decision about whether it can provide the care, and only the military facility can release the referral back to the civilian network.

You also cannot request a specific specialist within Womack once the assignment is made through this process. The facility assigns the appropriate provider internally.

If you believe there are continuity-of-care circumstances that warrant an exception, those requests go through Humana Military. Call 800-444-5445 to discuss your situation.

Active-duty service members have the most restrictive referral requirements. Under TRICARE Prime, a referral is required for all care not provided by the PCM, including urgent care visits outside the military clinic. Going outside the system without a referral can result in the service member paying out of pocket.

For active-duty members assigned to Fort Bragg, the military clinic is typically the starting point for all care. Referrals from the military clinic follow the standard process: Womack gets first opportunity for specialty care, with civilian network providers as the secondary option if Womack cannot meet the need.

Not all care is subject to the Right of First Refusal. Outpatient mental health care from a network provider does not require a referral under TRICARE Prime, so you can schedule those visits directly without going through the referral process.

Emergency care is also handled separately: TRICARE covers emergency care without a prior referral, and you should seek emergency care at the nearest appropriate facility. If you receive emergency care at a civilian facility, notify Humana Military promptly.

For non-emergency specialty care, plan on the referral process and allow time for the Right of First Refusal review before you expect an appointment.