FALLS CHURCH, Va. –
Are you a
TRICARE Prime beneficiary living in the
West Region? Are you currently using a
referral to get specialty care?
If you used the West Region referral approval waiver to see a specialist between Jan. 1 and June 30, 2025 and need to continue seeing that specialist, you’ll need to get a new referral to a network specialist before Oct. 1, 2025.
If you’re still using a valid referral issued by a previous contractor before Jan. 1, 2025, you also need to get a new referral for any care received starting Oct. 1. You can confirm your referral information by logging into the TRICARE West Region Beneficiary Portal. (Note: If your referral expires before Oct. 1, it’s valid through its expiration date.) Otherwise, you may need to pay point-of-service fees.
“If you live in the West Region, it’s important that you take the time now to evaluate your current referrals,” said Jacob Sanchez, referral management subject expert, TRICARE Health Plan, at the Defense Health Agency. “Work with your primary care manager and plan ahead for specialty care you may need starting Oct. 1.”
Referrals issued during referral approval waiver period end Sept. 30
Are you currently getting specialty care under an active referral received via the referral approval waiver process?
Here’s what to know:
- You can continue receiving your care under the waiver through Sept. 30, without paying point-of-service fees, as long as the provider is TRICARE-authorized. Your care under that referral ends Sept. 30.
- If you need care after Sept. 30, you must go back to your primary care manager to get a new referral to your specialist. Contact your PCM to begin this process prior to Sept. 30.
- TriWest Healthcare Alliance, the West Region contractor, requires processing time to approve a new referral.
- Starting Oct. 1, point-of-service fees may apply if you see a non-network specialist. Use the West Region Provider Directory to find a network specialist.
- If you don’t receive a new referral, you may have to pay out-of-pocket costs.
It’s important to note that you don’t need to take any action if you live in the East Region or overseas.
Referrals issued before Jan. 1, 2025 end Sept. 30, 2025, or their expiration date—whichever is earlier
Do you have an active referral issued in the West Region before Jan. 1, 2025?
Here’s what to know:
Take action today
If you live in the West Region,
don’t wait. If you know you’ll need specialty care for a current condition after Sept. 30, and have one of the referrals mentioned above, reach out to your PCM today. They can work with you to issue a new referral and route it for appropriate approvals.
Learn more about the referral process with TRICARE Prime.
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