TRICARE West Region Provider Forms
Welcome TRICARE West Region providers! Here you will find a variety of forms you may need to manage your patients’ health care. You can download and print these forms.
Claims
- Claims Reconsideration
- Certificate of Medical Necessity
- EDI Gateway Technical Communications User's Manual
- EDI Provider Trading Partner Agreement
- Electronic Funds Transfer (EFT) & Electronic Remittance Advice (ERA) Enrollment Package
- Recoupment Request
- Timely Filing Waiver
- Request for Non-covered Services
Clinical Care
Non-Network Provider Application
- TRICARE Non-Network Autism Care Demonstration (ACD) (BCBA, BCBA-D and LBA) Individual Application
- Non-network TRICARE Provider File Group Application
Referrals and Authorizations
NOTE: A Primary Care Manager Referral Waiver is in place Jan. 1 - April 30, 2025.
Online referrals/auths is the fastest way to process care requests for your TRICARE patients. Read the referral/authorization guidelines to learn more.
If you have issues submitting your referral or authorization using the online referral management system, please use the Alternative Referral and Authorization Form available on Availity. For more information, view the Alternative Referral and Authorization Form Quick Reference Guide.
Already submitted via fax? Consider resubmitting online for faster response times.
- TRICARE West Region Referral/Authorization Form
NOTE: For fastest processing time and optimal results, please complete the form by filling out the PDF fields rather than hand writing.