CANNON AIR FORCE BASE, N.M – As of June 30, 2025, patients have the option to not visit the TRICARE Operations and Patient Administration Flight (TOPA) to “activate” a referral, unless a specialty provider requests notes. This hastens the referral process, allowing patients to see specialty providers in the network as soon as necessary.
For members and families with TRICARE Prime, if your Primary Care Manager (PCM) determines you need medical treatment they can’t provide, they can put in a referral for specialty care.
“Any time that your PCM determines that you need specialty care that we can't offer in the primary care clinics, you will receive a referral,” explained the TOPA flight chief.
Certain specialty care providers require that the patient’s medical notes are reviewed before seeing the patient, and in some cases before they book the appointment.
Under the previous referral process, patients were directed to visit TOPA after their initial appointment with their PCM, where they would “activate” their referral, fill out a request for notes to be sent to the specialist, and receive the TRICARE Prime travel benefit brief. This is no longer required.
“The goal of the new referral process is to improve access to specialty care with a more seamless process,” said the TOPA flight chief.
With the new referral process, patients wait two to three business days after their PCM appointment to review their referral on the TriWest Patient Portal. Using the information on the TriWest Patient Portal, patients call the specialist and schedule an appointment.
If the specialist notifies the patient that they require clinical notes to be seen, then the patient should call or visit TOPA to have the necessary notes faxed. On average, it takes eight to ten business days for the specialty care clinic to receive the notes.
Once the patient has an appointment with a specialist, provide the date and time to Referral Management - TOPA, or the patient will receive automated phone calls as a reminder to book their specialty care appointment.
Any specialty referrals submitted between January 1, 2025 and June 8, 2025 - with the exception of inpatient care, applied behavior analysis/autism care demonstration services, laboratory developed tests, extended care health option services and other services that require pre-authorization – will still fall under the TRICARE West Region Referral Waiver and follow a different process. These referrals are valid until September 30, 2025 and can be viewed on the MHS GENESIS Patient Portal.
For more information, refer to the following: