October 2025 Provider Pulse

Know What Care Requires a Referral

Certain specialty care for TRICARE Prime Beneficiaries requires a referral. TRICARE Select Beneficiaries do not need a referral but do require pre-authorization for some services.

To determine if care needs a referral or authorization, use the Referral and Authorization Decision Support (RADS) tool on the provider portal.

Submit Medical Documentation for Denied Claims

If you have received a claim denial due to the lack of medical documentation, please mail or fax the medical documentation. You do not need to submit a reconsideration request to TriWest, as this will delay the review and reprocessing of your claim.

Mailing Address: TRICARE West-Med Records PO Box 202165 Florence, SC 29502 Fax: 877-989-0047

When submitting a claim reconsideration, providers must also include:

• A copy of the initial denial (EOB/provider remittance advice)
• Any additional claim identification documentation to support the appeal or reconsideration (claim ID number, date of service)

For more information, visit the TRICARE Reconsiderations and Appeals page.

Reminder: Virtual Health Options Available for Beneficiaries

TRICARE offers a variety of virtual care options to TRICARE West Region beneficiaries. Virtual care may help some of your TRICARE patients by providing access to care from the comfort of their home.

TriWest has contracted with telehealth groups to support the following clinical services virtually:

• Virtual Urgent Care
• Virtual Mental Health
• Virtual Psychiatry
• Virtual Dermatology
• Virtual Speech Therapy

To learn more about virtual health options available visit the Virtual Health Network Partners page.

Referring Patients to Virtual Care

If you have patients who prefer virtual care, you can refer them to one of TriWest’s contracted virtual providers. These referrals ensure that beneficiaries receive timely, high-quality care in the setting that best fits their needs. When creating a referral to virtual providers please direct to one of our virtual groups/providers or highlight that the beneficiary prefers virtual options within the referral.

Confirming Your Own Telehealth Services or Capabilities

If you are a provider that offers virtual health options and have not already completed our telehealth onboarding, please contact telehealth@triwest.com to ensure your information accurately reflects your capabilities.

Registration Open for Suicide Prevention Training

The Center for Deployment Psychology (CDP) has opened registration for Cognitive Behavioral Therapy Suicide Prevention (CBT-SP) training.

The CDP offers these courses to equip mental health providers with evidence-based tools to treat and reduce suicidal behaviors and ideation in the military community.

Additionally, there are two other suicide prevention-focused workshops available for providers:

• Suicide Prevention Considerations for Prescribing Providers: This intensive one-day module provides training in the assessment and management of suicide ideation and behavior. Participants will be introduced to the Self-Directed Violence Classification System (SDVCS), which is supported by the Departments of Veterans Affairs and Defense for self-directed violence and suicidal behavior.
  • CME Credits offered: 4.50 (If this is your first time registering for this workshop you will be required to create a free account with our CME provider.)
• Suicide Prevention Working as a Behavioral Health Technician in the US Military: This one-day module provides training in the assessment and management of suicide ideation and behavior. The module is designed for Behavioral Health Technicians (BHTs) working with service members who are seeking training in empirically supported treatment options they can immediately incorporate into their clinical practice. No credits are offered.

All CBT-SP, BHT-SP, and Prescribing Providers training courses are free.

How to Register

• Visit the CDP website.
• Click on the training you would like to attend.
• Click on the yellow “Register now” button.

Learn How to Screen for Cancer with Grail Galleri^® Test

TriWest is pleased to announce that the Grail Galleri^® test is now covered under TRICARE! This is a new cancer screening test that detects over 50 types of cancer with 76% sensitivity. If you have a TRICARE patient who is 50 years or older, has not received the Grail Galleri^® test in the last five years, and has one or more of the following risk factors, they may benefit from the Grail Galleri^® test:

• Personal history of cancer (cancer that required immediate intervention; must be at least 3 years since last treatment)
• Family history of cancer (two or more first-degree relatives)
• Smoking and vaping if over 20 pack-years (either currently or in the past 15 years if patient quit)
• Human immunodeficiency virus (HIV)
• Previous solid organ transplant

The test looks for a unique “fingerprint” of cancer by analyzing methylation patterns of cell-free DNA (cfDNA) in a patient’s blood. If detected, the test predicts the most likely origin of the cancer signal to help guide the diagnostic workup.

You must obtain a preauthorization from TriWest before ordering the test. Learn more about the Grail Galleri^® test on the Grail Galleri^® Quick Reference Guide or the Grail Galleri^® Test web page.

TRICARE Provider Handbook Updates

There are currently no updates to the TRICARE Provider Handbook.