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TRICARE Access to Care Standards

BJACH Leadership

Access to Care standards differ by the TRICARE program assigned to each patient.

TRICARE Prime beneficiaries are entitled to the following access to care standards with 32 CFR 199.17(p)(5)(ii):

   A. Emergency Care: Beneficiaries seeking emergency care should proceed to the
       nearest emergency room or call 911 (or other local emergency assistance number)
       for immediate medical attention. In accordance with DoDD 6000.14, Military Health
       System (MHS) beneficiaries have the right to access emergency healthcare
       services when and where the need arises. Emergency services are covered in
       circumstances where acute symptoms are of sufficient severity that a "prudent
       layperson" could reasonably expect the absence of medical attention would result
       in serious health risks or death. Call your Primary Care Manager (PCM) or Southern
       Regional TRICARE Office (-1800-444-5445) within 24 hours of your visit so a
       retroactive referral can be placed to ensure a bill in not generated to you for
       services.

   B. Urgent Care: Beneficiaries should have an appointment to visit an appropriately
       trained provider within 24 hours and within 30 minutes travel time of the
       beneficiary's residence. If this appointment cannot be provided within these
       access standards either in a military treatment facility (MTF) or the civilian
       network, the beneficiary must be offered a referral and authorization to seek
       urgent care outside the civilian network. Urgent care is defined as a non-
       emergency illness or injury for which you need medically necessary treatment.
       An urgent care condition will not result in further disability or death if not treated
       immediately; however, treatment should take place within 24 hours of illness or
       injury to avoid further complications and unnecessary suffering. Please go to the
       BJACH Emergency Room to receive Urgent Care services.

   C. Open Access: If you require a Primary Care appointment, the access standard is
       the same day of your request. Whether you have an acute issue (i.e., cold
       symptoms) or need a wellness check (i.e., well woman’s exam, well child) the clinic
       will work to schedule you an appointment.

   D. Established (Follow-up): Access standards do not apply to follow-up
       appointments as the provider determines the next visit.

   E. Specialty and Wellness Services: If your provider requests a specialty
       appointment as a result of your visit, (i.e., surgery, obstetrics, behavioral health,
       etc.), the standard is 28 days.

If the clinic is not able to meet these access standards, they will offer you a referral to a TRICARE civilian network provider.

These standards also apply to our civilian TRICARE Prime enrolled beneficiaries with civilian network PCMs.

Beneficiaries not enrolled in TRICARE Prime will be seen on a space available basis.

Office Waiting Times: 32 CFR 199.17(p)(5)(ii) states that office waiting times in non-emergency circumstances shall not exceed 30 minutes, except when emergency care is being provided to patients and the normal office schedule is disrupted. If you have been waiting more than 30 minutes, please inform the front desk staff.

Col Marla J. Ferguson
CSM Roderick D. Taylor
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