TRICARE Urgent Care Pilot Launched
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On May 23, 2016, the Defense Health Agency (DHA) launched its congressionally mandated urgent care pilot for TRICARE beneficiaries.  Under the three-year pilot, TRICARE beneficiaries will be allowed two unauthorized urgent care visits per fiscal year. Beyond the two urgent care visits without authorization, a TRICARE patient will be required to get a referral (or authorization) for an urgent care visit to be covered.

On June 15, the DHA hosted a webinar to educate TRICARE beneficiaries and providers about the pilot. More information about the pilot, including a fact sheet, can be found on the TRICARE website.

While UCAOA supports the pilot, there is concern the pilot, as structured, could be confusing to beneficiaries.  According to the TRICARE fact sheet, if a beneficiary contacts the TRICARE Nurse Advice Line and urgent care is recommended, the beneficiary must contact his/her primary care manager and get a referral for the urgent care visit. Absent a referral, the beneficiary will be liable for the cost of the visit unless the visit falls within the two visits without authorization. The construct of the pilot could deter providers from participating because it may be difficult to ascertain at the point of care whether the patient has received a referral from a primary care manager or has exceeded the two visits without authorization.

Urgent care centers interested in becoming an urgent care provider should contact the managed care support contractor responsible for administering the TRICARE program in their region.

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