Meeting Access Standards: Obligations for TRICARE Network Providers

Under normal circumstances, TRICARE Prime beneficiaries should have access to providers within specific time frames and certain distances from their homes.

Access Standards

TRICARE network providers servicing TRICARE Prime beneficiaries are obligated to meet the following access standards for appointments:

• For urgent care or acute illness, patients should receive an appointment within 24 hours.
• For routine visits, patients should receive an appointment within one week.
• For specialty care or wellness visits, patients should receive an appointment within four weeks (28 days).
• Once in the office, patients should be seen within 30 minutes for nonemergencies, except when providers are rendering emergency care to other patients and the normal schedule is interrupted. Patients should be notified of the cause for the delay and the length of delay anticipated, and then offered a rescheduled appointment.

Drive Time

Primary care managers (PCMs) should understand that beneficiaries are entitled to receive primary care within a 30-minute drive from their home under normal circumstances. When helping patients with referrals to specialists, PCMs should also be aware that TRICARE Prime beneficiaries are to receive specialty care within an hour’s drive from their home.

Verifying the Standards

Meeting the TRICARE Prime access standards is an essential condition for network providers. Network providers must notify TriWest within 30 days of any change to demographic information, panel status or ability to meet the appointment standards.