TRICARE Referral and Authorization Guidelines
Use the Online Referral Management System on provider portal, 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
- Log in to the provider portal at 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 the provider portal, Availity for referral and authorization webinars and on demand options.
Referral Submission Guidelines: Diagnosis, Provider, and Authorization
When submitting requests for subsequent or additional care, please keep three things in mind:
- List the originally approved diagnosis as the primary diagnosis. Additional diagnoses may be added as needed, but only as secondary.
- Ensure the requesting provider is the same provider to whom the referral was authorized.
- Confirm the requesting provider has an approved Primary Care Manager (PCM) referral and is using the same approved diagnosis and specialty to which care was originally authorized.
Following these steps helps requests process smoothly and without delay.
Identify What Care You’re Requesting
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 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 the provider portal, 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 and authorization through the online referral management tool, please contact TriWest via the chat feature in Availity or at 888 TRIWEST (874-9378). We’re here to help Monday – Friday from 8 a.m. to 6 p.m. in your time zone.