February 2025 Provider Pulse

New to TRICARE? Avoid Delays with these Claims Submission Tips

Electronic claim submission is required for TRICARE network providers. Get real-time status updates at any time for an unlimited number of claims on Availity. Check multiple claims and view remittances online.

Claims submitted electronically are less likely to be rejected compared to paper claims. Improve your claim submission accuracy and get your payments faster by signing up for electronic claim submission.

Register on Availity to:

• Enroll in EDI claims submission.
• Check claim status.
  • Select Claims & Payments at the top, then Claims Status.
• View/print a TRICARE Remittance Advice.
• Enroll in Electronic Funds Transfer and/or Electronic Remittance Advice.

For more information visit the TRICARE Claims Guidelines web page.

Note: Network providers in Alaska are not required to submit claims electronically. Alaska providers can submit via one of the options below:

• Submit Electronic Claims: (Use Payer ID 99726)
  • XPressClaim – A secure, full-service online claims submission tool. Please note that XPressClaim is a one-claim-at-a-time product and works best for providers who need to submit 150 claims or less per month.
  • Claims clearinghouse – A third-party organization that acts as a liaison between health care providers and insurance companies, or other payers, to process medical claims electronically.
  • Availity’s Basic Clearinghouse –TriWest’s self-service, secure provider portal.
• Submit Paper Claims:
  • Scan paper claim into an electronic format legibly and appropriately. When filing paper claims, you must use one of the following:
    • A CMS 1500 form (for professional charges).
    • A CMS UB-04 form (for institutional charges).
  • Include all required information to prevent delays in processing:
    • Completed Claim Form: Fill out all sections of the claim form accurately.
    • Supporting Documentation: Attach any necessary documentation, such as itemized bills or medical records.
    • Provider Information: Include your provider information, such as name, address, and National Provider Identifier (NPI).

Mail TRICARE West Claims to P.O. Box 202160, Florence, SC 29502-2160.

New Provider Trainings: Referrals & Authorizations and Telehealth & Telemedicine

We are excited to introduce two key training resources to support you in delivering care to TRICARE beneficiaries.

The Referrals and Authorizations Management Tool Training

As of February 18, we are sharing a new and improved version of the Referrals and Authorizations Management Tool training, which you can now register for in Availity, the provider portal.

This updated training features improved step-by-step instructions for submitting referrals and authorizations and addresses common provider questions. After completing this training, providers will be able to:

• Identify where to submit referrals and authorizations for TRICARE West Region beneficiaries.
• Describe the purpose and benefits of CareAffiliate.
• Navigate the CareAffiliate interface.
• Submit and track referral and authorization requests.

Telehealth and Telemedicine Webinar Recording

Now available, this recorded webinar provides an overview of TRICARE and TriWest requirements for telehealth and telemedicine services. This valuable resource keeps providers informed about virtual care policies.

Access these trainings in the Availity provider portal to enhance your understanding and streamline patient care!

TRICARE Primary Care Referral Approval Waived Through March 31

The Defense Health Agency (DHA) has implemented a temporary waiver of primary care referral approvals. Referrals from military or civilian primary care managers, or other TRICARE-authorized providers, do not require separate approval from TriWest during the waiver period. The waiver is for Jan. 1– March 31, 2025. A copy of the TRICARE West Region Referral Waiver Approval Letter is not required with a claim submission.

For details, see the Primary Care Manager Referral Waiver letter.

Getting TRICARE beneficiaries the care they need is our top priority. We thank you for your commitment to serving TRICARE West Region beneficiaries.

TRICARE Provider Handbook Updates

There are currently no updates to the TRICARE Provider Handbook.