Referral Management Center

What is Referral Management?

Guiding your journey to wellness. We personally coordinate and schedule your appointments with the right medical specialists at David Grant Medical Center. Should your care require a referral to the civilian network provider, our team will provide comprehensive guidance throughout that process so you can focus on what matters most—your health.

How are referrals activated?

We activate and manage referrals for a wide spectrum of medical specialties, including cardiology, dermatology, orthopedics, neurology, and more. Our dedicated team ensures you are connected to the appropriate specialist, handling all the necessary coordination so you can receive the expert care you need without delay.

Referral process

Step 1: Receive referral from your PCM

Step 2: Go to the Patient Service Center to start your referral. You can also verify your contact info is up-to-date and make changes if you need to while you are here as well. If you cannot visit the Patient Service Center, call the Referral Management Center at (707) 423-7641.

Step 3: If your referral is for a specialty clinic in-house at David Grant Medical Center, you should be able to book your initial appointment in person at the Patient Service Center, or by calling Referral Management Center. If you do not schedule your appointment, you will receive automated calls until your appointment is scheduled. Once your initial appointment is scheduled, there is nothing left for you to do other than attend your specialty appointment. You can stop here in the process.

Step 4: If your referral is sent to a network provider (off base), TriWest will send you a letter to the address on file with the providers’ contact information and location. You would need to call your network provider and book an appointment. Ask the network provider if previous medical records are needed for the appointment, if not, see Step 6 below.

Step 5: If Step 4 is applicable, have the provider contact DGMC’s Release of Information (ROI) by calling 707-423-5359, OR fax a records request to 707-423-5125. The patient can also stop by the PSC to allow us to fax your records to the network provider.

Step 6: Attend network provider appointment, bring the authorization number with you. Ensure you provide your network provider with your Benefits Number located on the back of your Military ID card.

Step 7: After the appointment, request that the Network Provider fax results to RMC at DGMC 707-423-7535 to ensure the continuity of your care!

 

Need a copy of your authorization letter? You can get a copy of your authorization letter by visiting www.tricare.triwest.com OR by calling TriWest at 1-888-874-9378 and have them fax it to your network provider.

 

How to obtain a copy of your authorization

Step 1: To create an account on TRICARE website, navigate under “BENEFICIARY” and fill out the required information.
Step 2: From the Home Screen, under Manage My Care click “AUTHORIZATION STATUS” and               enter patient information.
Step 3: Click on “Referrals/Authorizations” under “Manage My Care.”
Step 4: Select the appropriate authorization number.
Step 5: Contact your network provider listed on authorization letter to schedule your off-base appointment.
Step 6: Have authorization number available and bring it to your off-base appointment.
Step 7: Request the network provider to fax the results of your visit to the RMC at DGMC 707-423-7535.

**If your authorization is not available on https://tricare.triwest.com please contact the RMC at 707-423-7641**

Medicare Patients

MEDICARE is considered your primary payer. An authorization for referrals from TRICARE is not required. Call MEDICARE at 1-800-633-4227 or the RMC at 707-423-7641 if you have any questions.

Additional Information

How do I make changes to an authorization?

• Visit the TRICARE website to see a comprehensive list of network providers for the selected specialty.
• Some provider changes can be made using our Check Authorization and Referral Status tool. Use this tool to check your authorization/referral status and make provider changes.
• You can also contact TriWest at 1-800-874-9378 to inform them of your new provider selection and to have the provider updated.
• Referral requests entered to a specific provider by your PCM require a new referral if that provider is not available.
• You can only request a change in specialist provider if the referral has not been used to see the specialist already. 

How do I obtain additional care from my specialist?

• Specialists must request additional office visits, procedures, tests, or injections from TriWest via Availity.
• If the Specialist feels you need to be seen by a different specialist, you must contact your PCM at DGMC to request a referral to the new specialist.
• If you require ongoing care from your specialist and your referral dates have expired, you must reengage with your PCM at 60 MDG for a new referral.

What is TriWest?

• TriWest is the Managed Care Support Contractor for TRICARE health benefits. TriWest processes and authorizes (or denies) all referrals for care outside of the 60 Medical Group (DGMC).  TriWest is the approving authority for all surgeries, procedures, and tests requested by network providers on your behalf in the TRICARE West Region.

Frequently Asked Questions

1. Do I need a referral for an Emergency Department (ED) or Urgent Care (UC) Visit?
- Emergency? Go to the ER. No referral needed.
- Urgent Care:

• Active Duty → Call first for approval (after hours - Nurse Advice Line 1-800-874-2273; duty-hours - 707-423-3000, Option 1)
• Everyone else → Go directly, no referral needed.

2. What should I bring with me to my off-base specialty appointment?
Authorization Number, ID Card, Insurance Card/Other Health Insurance Card (if applicable), Medical Records (if provider requests them).
3. What should I do if I receive a bill for care that has been authorized?
Please contact our Beneficiary Counseling Assistant Coordinator and Debt Collection Assistant Officer, at 707-423-7921 or 707-423-3472. You can visit them in-person at the PSC by selecting “Benefits Counselor” on the kiosk. 
4. What happens if I see a specialist without a referral?
You are choosing the Point of Service option, in which you may be liable for a portion of the bill.
5. What if a specialist downtown needs information from my medical records?
They may contact the Release of Information (ROI) Office at 707-423-5359, M-F, 0730-1630.  Requests can also be faxed to 707-423-5055.
6. What happens if I don’t use my referral? Will it expire? Do I need to see my PCM again?
Yes, your referral will expire after 180 days. You will need to see your PCM to obtain a new referral and authorization, BEFORE seeing a network provider.
7. Does having other health insurance Medicare change the referral process?
Yes, all other insurances are primary & you may not receive authorization for care. Please follow the rules of your primary insurance. The referral process does not apply to Medicare patients.
8. What happens if my civilian provider wants to order additional surgeries, exams, or other procedures that require prior approval?
It is your civilian provider’s responsibility to request approval from TriWest.
9. Will I get a copy of my referral/authorization in the mail?
No, TRICARE stopped mailing patients a copy of their referral in the mail.  You can get a copy of your authorization by going to the TRICARE website.