FALLS CHURCH, Va. –
*Note: This article was updated March 26 to reflect the payment deadline extensions until April 30. It was also updated to include a message from Acting DHA Director Dr. David J. Smith. It was updated May 5 to to reflect the extension of the referral approval waiver through June 30, the point-of-service fee waiver through Sept. 30, and the date that TriWest will accept the previous contractor's referrals to Sept. 30 (or their expiration, whichever comes first).*
On Jan. 1, TRICARE began delivering health care under its new regional contracts. This means that TriWest Healthcare Alliance is now the contractor for the TRICARE West Region, including six states that moved from the East Region. (Humana Military remains the contractor for the states that have stayed in the East Region.)
The Defense Health Agency is aware that some West Region beneficiaries have experienced challenges since Jan. 1. These include:
- Payment set-up
- Call center wait times
- Network provider availability
- Processing of referrals and authorizations
- TriWest beneficiary portal access
Together, the DHA and TriWest are actively implementing strategies to address these concerns. Processes are improving each day. The DHA understands that this period is important for keeping your healthcare coverage. The DHA remains committed to ensuring the best possible care for all beneficiaries.
You can read more in a March 26 message to West Region beneficiaries from Dr. David J. Smith, Acting DHA Director.
It’s important to know that no beneficiary has lost their TRICARE coverage due to this transition.
Keep reading to learn more about how the DHA and TriWest are working to improve the experience for West Region beneficiaries.
Calling your regional contractor
Do you live in the West Region? You can call TriWest at 888-TRIWEST (874-9378).
The DHA is aware that West Region callers are experiencing significant hold and resolution times. The DHA is working with TriWest to reduce wait times and ensure that you’re able to get the answers you need.
Since Jan. 1, TriWest has hired over 400 additional customer service representatives. They’ve also added a call-back feature to reduce call wait times. This feature is available during especially busy periods. If you choose this option, you don’t need to wait on hold. A TriWest representative will return your call when it’s your turn in line.
Note: The outgoing contractors—Health Net Federal Services, LLC, and Humana Military (for the six states that moved from the East Region)—can no longer assist West Region beneficiaries. Only call your previous contractor to ask about claims with dates of service before Jan. 1. For all other questions, reach out to TriWest.
Providing your payment information to TriWest
Do you pay for your TRICARE coverage using a bank electronic funds transfer, credit card, or debit card? You must provide your recurring payment information to TriWest now.
The DHA has extended the payment deadline in the West Region. You now have until Wednesday, April 30 to provide your payment information. This may apply to you if you have:
If you don’t act before this date, you’ll be disenrolled, retroactive to Jan. 1.
The easiest way to provide your payment information is through TriWest’s secure beneficiary portal. Thousands of beneficiaries have used the portal to submit their payments.
It may take up to 48 hours to see your payment information in the portal. You can keep an eye on your portal status and bank statements to check that the payment has gone through. You can also take screenshots of these screens and save receipts for proof of payment.
Not sure if you need to give your payment information to TriWest? Check out the TRICARE Newsroom article, “Act Now! Payment Deadline Extended for West Region Beneficiaries.” Visit www.tricare.mil/west to see your options for payment.
Remember: This doesn’t apply to you if you pay by military pay system allotment. Allotment payments have transferred automatically.
Accessing TriWest’s portal
While TriWest experienced occasional outages of its secure beneficiary portal at the start of health care delivery, they recently made several portal improvements to help enhance the beneficiary experience.
To create an account and manage your health information, you need to use the same email that’s in the Defense Enrollment Eligibility Reporting System. Make sure to check that your information is current in DEERS before creating your account.
Finding network providers
TriWest has built a large provider network. Over 97% of West Region beneficiaries have access to all provider specialties. TriWest’s network includes almost all of Humana Military’s network in the six transition states. It also includes over 80% of the providers that were in HNFS’ network. TriWest continues to load contracted providers into their directory and actively expand their provider network to ensure you have access to care.
Check out TriWest’s network provider directory to find a network provider near you.
Do you know a provider interested in joining TriWest’s network? They should visit Join the TriWest Healthcare Alliance Network.
Using referrals and authorizations
Do you have
TRICARE Prime? If so, you may have some questions about your active
referrals and authorizations.
TriWest is actively loading 2024 referrals and authorizations to their portal. This means they’ll be available to you and your providers. Many referrals and authorizations are now available in the portal. More are being added daily.
On Jan. 25, the DHA announced that it waived the requirement to obtain approval for referrals to outpatient specialty care for TRICARE Prime enrollees in the West Region. This means TRICARE-authorized specialty care providers don’t need to wait for TriWest to approve referrals issued by your primary care manager before providing outpatient care. However, you still need to get a referral from your PCM before getting that specialty care.
There are exceptions for certain services. The waiver will be in place through June 30 and is retroactive to Jan. 1. Check out “Defense Health Agency Announces TRICARE West Region Referral Approval Waiver” on the TRICARE Newsroom to learn more.
Do you have an unexpired referral or authorization dated before Jan. 1, 2025? TriWest will accept all unexpired referrals and authorizations approved by the previous contractor (Humana Military or HNFS). These will be accepted through their expiration date, or Sept. 30, 2025, whichever comes first. Your PCM doesn’t need to take additional action to get these approved again.
Do you have a question about a referral or authorization dated before Jan. 1? You should call TriWest.
If your provider is no longer a TRICARE network provider, you can keep seeing them and pay TRICARE Prime copayments. Starting Oct. 1, if the provider is still a non-network provider and isn’t named on the referral or pre-authorization, you’ll need to pay point-of-service fees. Make sure to get a new referral or pre-authorization before the old one expires, or by Oct. 1.
When possible, keep copies of all your referrals and pre-authorizations. This includes those from your previous contractor.
Moving forward
The DHA continues to monitor TriWest’s operations and is committed to ensuring an effective transition for all TRICARE beneficiaries. Beneficiaries are thanked for their patience and cooperation during this transition period.