How to Get TRICARE Authorization: 2026 Guide | TRICARE.com

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## Quick answer To get a TRICARE authorization, your primary care provider (PCM) must submit a request to your regional contractor (Humana Military in the East or TriWest in the West). Most specialty care and medical equipment require this "prior authorization" to ensure the service is medically necessary and covered before you receive it.

Details

An authorization is a formal approval from TRICARE for a specific service, procedure, or medical device. While "referrals" send you to a specific doctor, "authorizations" confirm that TRICARE will pay for the treatment that doctor recommends.

### The Standard Process 1. **The Consult:** You visit your Primary Care Manager (PCM). 2. **The Request:** If the PCM determines you need specialty care (like an MRI, surgery, or durable medical equipment), they submit an authorization request electronically to your regional contractor. 3. **The Review:** The regional contractor reviews the request against clinical necessity guidelines. 4. **The Notification:** You can check the status of your authorization via your regional contractor’s secure portal. You will typically receive an authorization letter by mail or online with an expiration date and specific instructions.

### Regional Contractors (As of 2026) * **East Region (Humana Military):** Covers the eastern U.S. PCM submissions go through the Humana Military provider portal. * **West Region (TriWest Healthcare Alliance):** Covers the western U.S. (Since Jan 1, 2025). TriWest manages all specialty care authorizations for West beneficiaries. * **Overseas (International SOS):** For those stationed outside the U.S.

### When Is Authorization Required? Under **TRICARE Prime**, almost all specialty care requires prior authorization. If you seek specialty care without an authorization, you will likely be charged under the **Point-of-Service (POS) option**, which carries a high deductible ($300 for individuals / $600 for families in 2026) and 50% cost-shares.

Under **TRICARE Select**, authorizations are generally not required for most office visits with network specialists. However, specific high-cost services still require approval: * Applied Behavior Analysis (ABA) * Home health care * Hospice care * Non-emergency inpatient admissions * Certain prescriptions (managed by Express Scripts)

### Checking Status and Timelines Authorization reviews typically take **2 to 5 business days** for routine requests. Urgent requests can be processed within 24–72 hours. To check status: * **East Region:** Log into your account at HumanaMilitary.com. * **West Region:** Log into your account at TriWest.com.

## Who this affects * **Active Duty Service Members (ADSMs):** Approval is mandatory for all specialty care outside of military hospitals. * **Active Duty Family Members (ADFMs):** Required if enrolled in TRICARE Prime or for specific high-cost services in TRICARE Select. * **Retirees and their Families:** Required for Prime enrollees; required for Select enrollees for specific procedure types. * **National Guard and Reserve:** Those on TRICARE Reserve Select (TRS) follow rules similar to TRICARE Select.

## Sources * TRICARE.mil: [Referrals and Authorizations](https://tricare.mil/referrals) * Humana Military (East): [Authorizations and Referrals](https://www.humanamilitary.com) * TriWest Healthcare Alliance (West): [Patient Portal](https://www.triwest.com) * Defense Health Agency (DHA): [T-5 Contract Information](https://health.mil)