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
• Electronic Funds Transfer (EFT) & Electronic Remittance Advice (ERA) Enrollment Package
• Recoupment Request
• Timely Filing Waiver
• Request for Non-covered Services

Referrals and Authorizations

• TRICARE West Region Referral/Authorization Form