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 patients.
Submit a Referral/Authorization Online for New Care Requests
- Go to Availity.com and access the TRICARE West box under Payer Spaces.
- Select the Applications tab.
- Choose the “Submit Referral/Auth” tile.
- Enter the referral management system; under “Select an Organization”, choose your organization in the drop down.
- Enter required data.
Need quick tips? Access the How to Submit Referrals and Authorizations Quick Reference Guide.
Need more detailed information? Access the Referral Management System User 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
Your TRICARE patient was referred to you under the referral approval waiver.
- Continue to care for the patient without an approved referral through September 30.
- Prior to October 1, if care needs to continue, coordinate with the patient’s primary care manager to obtain a new referral/authorization.
A new request for care requires a referral/authorization.
- Submit a new referral/authorization.
- See above for how to submit or get access to training on West Region systems.
A valid referral or authorization was already in place prior to Jan. 1, 2025.
- No need to contact TriWest for a new referral/authorization.
- Care continues and your claims will pay.
- Remains valid until referral/authorization ends or September 30, 2025, whichever comes first.
A new request for care does NOT require a referral/authorization (e.g., mental health).
- No need to contact TriWest for a new referral/authorization.
- 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.
Submission Problems?
If you have issues submitting your referral or authorization using the online referral management system, please use the Alternative Referral and Authorization Form available on Availity. You can now attach medical documentation directly to the form electronically. For more information, view the Alternative Referral and Authorization Form Quick Reference Guide.