Before testing under Tricare Prime, what is required?

Before testing under Tricare Prime, what is required?

• A. PCM referral
• B. Prior authorization
• C. Medical record upload
• D. PCP note

Answer: (A)

In Tricare Prime, a Primary Care Manager acts as the gatekeeper for tests and specialty services. Before testing can be arranged, you need a referral from your PCM. The PCM reviews the medical need, confirms the service is appropriate for Prime coverage, and directs you to the correct testing facility or specialist. While some situations may require additional authorization, the standard requirement for testing under Prime is the PCM referral. A PCP note or uploading medical records isn’t the usual prerequisite to obtain testing.

In Tricare Prime, a Primary Care Manager acts as the gatekeeper for tests and specialty services. Before testing can be arranged, you need a referral from your PCM. The PCM reviews the medical need, confirms the service is appropriate for Prime coverage, and directs you to the correct testing facility or specialist. While some situations may require additional authorization, the standard requirement for testing under Prime is the PCM referral. A PCP note or uploading medical records isn’t the usual prerequisite to obtain testing.