TRICARE September 2026 Provider Pulse

TRICARE Virtual Community Groups: Support Beyond the Visit

Virtual Community Groups offer a safe, welcoming space to support beneficiaries beyond primary visits. TRICARE West Region Virtual Community Groups are online sessions led by trained health experts focusing on topics like diabetes, prediabetes, tobacco and vaping cessation, and mental health.

These interactive groups give beneficiaries the opportunity to connect with others facing similar health challenges, share experiences, and learn about practical ways to improve their health. These sessions also make it easier for beneficiaries to stay engaged by reducing common barriers like transportation and access.

Help us encourage your TRICARE patients to sign up for an upcoming session. Monthly topics vary, so check back frequently.

How can beneficiaries register?

• Sign in to the West Region beneficiary portal.
• Click on the “Manage My Care” tab.
• Scroll down to “Virtual Community Groups”. A list of upcoming sessions will be shown.
• Click the “register” button for the selected session.
• Save the confirmation email with the link to the session.

When all steps have been completed, a registration confirmation email and link to the event will be sent.

To refer a TRICARE patient for additional clinical support, complete the Clinical Care Support Program (CCSP) referral form.

Check out the TRICARE West Region Disease Management support and programs page for more information. Have questions? Email the TRICARE West Region Disease Management team at WellnessTeam@triwest.com.

Thank you for actively partnering with Disease Management to connect TRICARE beneficiaries with support for their health and wellness journey.

New TRICARE Telehealth Preference Option Enhances Referral Submissions

New enhancements are now available on the TRICARE referral submissions in Availity to accommodate telehealth preferences.

When submitting a referral, if the selected referral profile is appropriate for telehealth services, you will now see a new option to indicate the beneficiary’s preference for receiving care via telehealth. This change is designed to make referrals easier and more efficient for your TRICARE patients.

What’s New

• A telehealth preference option will now display for telehealth-appropriate referral profiles.
• Providers can indicate whether the TRICARE patient prefers to receive services through telehealth at the time of referral submission.

This enhancement helps ensure beneficiary preferences are captured and supports timely access to clinically appropriate telehealth services.

TRICARE and Military Treatment Facilities: Understanding MTF Roles in Care Delivery

Military hospitals and clinics are known as military treatment facilities and are usually located on most military posts, bases, and installations. The TRICARE provider network supplements MTF resources to ensure that TRICARE beneficiaries get the care they need.

The MTF’s goal is to maintain active duty readiness for military contingency operations with the primary responsibility for providing care to TRICARE beneficiaries within their capabilities and capacities.

To provide care effectively and efficiently, MTFs retain the right to accept referrals for TRICARE beneficiaries when they have the capabilities and capacity to provide the required services. These referrals are known as Knowledge, Skills, and Abilities (KSA) referrals.

Here are some important reasons that MTFs choose to deliver Prime-referred services.

• They ensure all medical service forces are ready to perform by keeping their skills current.
• They ensure MTF optimization, which helps to contain health care cost for TRICARE beneficiaries.
• They assist in determining prevalent MTF specialty access and adequacy needs for a particular TRICARE population.
• They enhance the military graduate medical education program.
• They hone the skills of military providers rotating through the MTF.

Referring Care to TriWest

If the MTF can’t provide the requested services, the beneficiary is referred to a TriWest Healthcare Alliance (TriWest) network provider. However, if a TriWest network provider is selected before the MTF optimization determination and the MTF opts to provide the services, this overrides any prior network provider selection, and the beneficiary is required to be seen at the MTF.

TRICARE Prime beneficiaries who have received a referral for services are referred by TriWest to an MTF first when the MTF indicates they have the capability to provide that type of care. The MTF has the right to accept or refuse the referral.

TRICARE Expands the Opioid Safety Initiative

In 2013, the Veterans Health Administration developed and implemented the Opioid Safety Initiative to reduce high-risk opioid prescribing, track prescription patterns, and decrease reliance on long-term opioid therapy for chronic pain. OSI was adopted by the Defense Health Agency.

The program goal is to improve quality of life, reduce suffering from chronic pain, decrease opioid prescribing practices associated with complications, and promote safer opioid-related prescribing for active duty service members, Veterans and their families.

The OSI addresses the challenges of opioid dependency and closely monitors Department of War and VA dispensing practices system-wide, including care that occurs in the community. It coordinates pain management through patient and provider education, enhanced testing and safety monitoring, thoughtful tapering plans, the use of complementary integrated health modalities (i.e., acupuncture, massage therapy, yoga, etc.) and cognitive behavioral therapy for pain.

Recommended actions for providers to take include:

• Perform a thorough assessment including all prior treatment approaches
• Set realistic expectations for pain management early and review those expectations often
• Request non-pharmacological/non-opioid treatment options when appropriate
• Proceed with opioid treatment with caution, as briefly as possible with the lowest dose immediate release option
• Reassess progress and safety at every visit
• Stop and reassess if concerns begin to occur
• Submit requests for substance abuse treatment when needed

DHA’s Research & Engineering Implementation Science Branch created the Opioid Overdose Education and Naloxone Distribution Program to combat opioid overdoses by increasing naloxone access and education, ultimately saving lives. The Naloxone and Opioid Safety Guide was produced to give providers more information regarding naloxone.

TRICARE Provider Handbook Updates

There are no updates to the TRICARE Provider Handbook this month.