Prime Enrollment and PCM Change Application

Use this form to:

If you need to enroll in TRICARE Reserve Select (TRS), click here to be taken to the Guard and Reserve Web Portal.

Step 1. Choose your first and second preference for a Primary Care Manager (PCM) from the Provider Directory. Final PCM assignment is dependent upon provider availability and local Military Treatment Facility (MTF) policy.

Important:
  • Active Duty Service Members (ADSMs) are required to enroll with their servicing MTF unless they qualify for TRICARE Prime Remote Status. If you are an ADSM, you should contact either the Managed Care Office at your MTF, or your TRICARE Service Center (TSC) before submitting your enrollment application.


  • If you are an Active Duty Family Member (ADFM) who would like to receive medical care from an MTF PCM, you should contact either the Managed Care Office at your MTF or your TSC before submitting your enrollment application.


  • MTF provider assignments are coordinated by the Managed Care Office at your MTF or through the local TSC. MTF providers are not listed in the online Provider Directory.
Step 2. Complete the Prime Enrollment Form
  • Personal information entered on the form must match the information in the Defense Enrollment Eligibility Reporting System (DEERS). You can update DEERS online or by phone at 1-800-538-9552.


  • If you have not established a residence at the time you are completing this form, enter "To Be Determined" in the Residence address block and complete the Mailing address block. The addresses and telephone numbers you include on this form will update DEERS.
Step 3. Print the form. Sign and date the application in blue or black ink.

Important:
  • Forms that are not signed and dated are considered incomplete and cannot be processed. Incomplete forms will be returned, which will delay the enrollment process.


  • Make a copy of the completed form for your records.
Step 4. Send the completed form to the appropriate address below:

If enclosing payment:
TriWest Healthcare Alliance
P.O. Box 43590
Phoenix, Arizona 85080-3590 		Mailing form only:
TriWest Healthcare Alliance
P.O. Box 41520
Phoenix, Arizona 85080-1520

If you are already enrolled in TRICARE Prime and would like to make a payment, please click here to learn about payment options including online payment, check or money order, allotment and electronic funds transfer (EFT).