Referrals are for services that are not considered primary care. An example of a referral is when a PCM sends a patient to see a cardiologist to evaluate a possible heart problem. For more information on referrals, visit our Prior Authorizations and Referrals page.
A statement sent to providers showing the outcome of claims processing.
The Reserve and Service Member Support Office (R&SMSO), formerly known as the Military Medical Support Office (MMSO), serves as the customer service point of contact for medical / dental case management for services outside of a military treatment facility. Services provided by R&SMSO are for TRICARE Prime Remote-eligible active duty military and National Guard and Reserve service members within the 50 United States and District of Columbia.
Includes the Army National Guard, the Army Reserve, the Naval Reserve, the Marine Corps Reserve, the Air National Guard, the Air Force Reserve, and the U.S. Coast Guard Reserve.
A former service member of one of the uniformed services who has retired.
Review performed after services have been provided.
A review by the military treatment facility (MTF) of civilian authorizations and referrals received by Health Net Federal Services, LLC to determine if the MTF is able to provide the services.