TRICARE Referral and Authorization Guidelines

Use the online referral management system on Availity to submit and view TRICARE West Region referrals and authorizations. It is the quickest way to get access to care for your TRICARE patients. Already submit a referral or authorization via fax? Try resubmitting online for faster processing times.

Submit a Referral/Authorization Online for New Care Requests

• 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.

Need quick tips? Access the How to Submit Referrals and Authorizations Quick Reference Guide.

Need training? Go to the TriWest Learning Center in Availity for referral and authorization webinars and on demand options.

Identify What Care You’re Requesting

A valid referral or authorization is already in place prior to Jan. 1, 2025.

• No need to contact TriWest for a new referral/auth.
• Care continues and your claims will pay.
• Remains valid until referral/auth ends or June 30, 2025, whichever comes first.
• Find authorizations and referrals for approved care (issued prior to Jan. 1, 2025) in the outgoing regional contractor’s secure portal.

A new request for care requires a referral/auth on or after Jan. 1, 2025.

• Submit a new referral/auth.
• See below for how to submit.

A new request for care does NOT require a referral/auth (e.g., mental health).

• No need to contact TriWest for a new referral/auth.
• Care can continue or start.

Unsure if care requires a referral or authorization?

Log in to Availity to use the Referral and Authorization Decision Support tool. Find it in Applications in the TRICARE West payer space.