Start with eligibility and plan

Confirm DEERS eligibility, the beneficiary’s current TRICARE plan and region, and whether the provider is TRICARE-authorized. The referral and authorization rules depend on plan and status.

Referral versus pre-authorization

A referral sends a patient to another provider; a pre-authorization is approval by the regional contractor before specified care. TRICARE states that active-duty service members need referrals for most care outside their assigned military hospital or clinic. When care is authorized, follow the provider and expiration instructions in the authorization letter.

Claims and deadlines

As of the October 4, 2026 verification, TRICARE states that U.S. medical claims generally must be filed within one year of the service or inpatient discharge, while overseas medical claims generally have three years; dental and pharmacy claims generally have one year. Use the current rule for the specific claim.

If TRICARE denies the request or claim

Read the EOB or denial letter first. TRICARE uses different appeal lanes for factual/payment disputes, medical-necessity denials, pharmacy disputes and Medicare-TRICARE issues. Current general guidance uses a 90-day filing period for many factual and medical-necessity appeals, but the decision notice controls the particular case.

• Preserve referral orders and authorization letters.
• Preserve provider status and appointment records.
• Preserve claims, EOBs, bills and proof of payment.
• Preserve the denial and every appeal submission.

Official sources

• TRICARE — Referrals and Pre-Authorizations
• TRICARE — Claim Filing Deadlines
• TRICARE — Appeals
• TRICARE — Secure Portals

Source status: SRC-001; SRC-018; SRC-033; SRC-034; SRC-035 verified October 4, 2026. Recheck current instructions before a deadline-sensitive transaction.