January 2025 Provider Pulse

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.

Submit TRICARE West Region Patient Referral/Authorizations Online

The quickest and most convenient option to submit referrals and authorizations for your TRICARE West Region patients is via the online referral management system on Availity.

• Go to Availity.com and access the TRICARE West – TriWest payer space.
• Select the Applications tab.
• Choose the “Submit Referral/Auth” tile.
• Enter the referral management system; under “Select an Organization”, choose “TriWest Healthcare Alliance TRICARE West” in the drop down.
• Enter required data.

Please refer to the How to Submit Referrals and Authorizations Quick Reference Guide for step-by-step instructions on submitting patient referrals or authorizations online. Need training? Go to the TriWest Learning Center in Availity for referral and authorization webinars and on demand options.

We encourage providers who have submitted a referral or authorization via fax to resubmit online for faster processing times.

Discover the Top 5 Things You Need to Know About TRICARE!

TriWest began administering TRICARE in the West Region on Jan. 1, 2025.

Want to know where to get started? Check out the new top 5 things to know as health care delivery begins.

TRICARE Provider Handbook Updates

An updated version of the TRICARE Provider Handbook is available online. The TRICARE Provider Handbook applies to TriWest network providers in the 26-state TRICARE West Region who provide health care services to TRICARE-eligible beneficiaries. Bookmark the handbook for easy reference. Updates to the TRICARE Provider Handbook will be communicated in future editions of the Provider Pulse newsletter.