Provider Certification and Credentialing

This page provides you with information about TRICARE certification and TriWest credentialing for the TRICARE West Region.

Provider Certification

Certified TRICARE-authorized providers are eligible to render services to and submit claims for TRICARE beneficiaries. To meet TRICARE requirements, TriWest must ensure that all providers are TRICARE certified according to regulations found in 32 CFR 199.6 and the TRICARE Policy Manual, Chapter 11.

Network Providers

You can download the certification application and other necessary documents for your provider type.

Applied Behavior Analyst (ABA) Certification Applications and Documents

Individual Provider/Practitioner Certification Applications and Documents

A complete certification application packet includes the certification application, required documentation listed on the application, and roster template. Submit your complete certification application packet to provcerts@triwest.com.

Non-Network Providers

If you have not signed a network agreement with TriWest, please complete the applicable TRICARE Non-Network Provider Application. Follow the instructions listed on the application to receive payment for claims.

Provider Credentialing

TriWest follows URAC credentialing standards, in addition to all applicable federal regulations and TRICARE requirements.

TriWest Delegated Providers

If you have signed a credentialing delegation agreement with TriWest, you have agreed to manage the initial credentialing and re-credentialing processes for your individual providers and/or ancillaries/facilities. As part of your delegation agreement, you will submit additions, changes/updates, and terminations to TriWest at least monthly. TriWest strongly recommends that you utilize the TriWest Provider Roster Template to ensure accurate and efficient processing of your data. Submit rosters to delegatedcred@triwest.com.

TriWest Credentialed Providers

If TriWest will complete the initial credentialing and re-credentialing processes for your individual providers and/or ancillaries/facilities, the TriWest Provider Roster Template may be used to submit additions, changes/updates, and terminations to ensure accurate and efficient processing of your data. Submit rosters to credentialing@triwest.com.

If you are an individual provider and participate in the Coalition for Affordable Quality Healthcare (CAQH), be sure to populate the CAQH ID field on the roster template. Also, ensure that your CAQH profile is updated and complete.

Individual providers that do not participate in CAQH need to complete the TriWest Individual Provider Credentialing Application and submit it along with required documentation to credentialing@triwest.com.

Ancillary and facility providers need to complete the TriWest Ancillary/Facility Credentialing Application and submit it along with required documentation to credentialing@triwest.com.

An updated W-9 form must be submitted when requesting a tax identification number (TIN), billing address, or organization or practice name change.

High Performing Provider (HPP) Program

The MHS includes a robust, innovative, enterprise-wide system to maximize education and training opportunities. These efforts help ensure a ready medical force and a medically ready force. A HPP is a designation TriWest gives to providers who excel in a set of standard health care evaluation metrics based on data available to TriWest.

Training opportunities for providers include:

  • Continuing Education Program Office
  • Defense Medical Modeling and Simulation Office
  • Defense Medical Readiness Training Institute
  • DHA Learning Management System
  • Leadership, Education, Analysis, Development, and Sustainment
  • Medical Education and Training Campus

Note: TriWest may use an HPP designation when selecting a provider for a beneficiary.

Mental Health Centers of Excellence Designation Program

TriWest is piloting a new program identifying Centers of Excellence for mental health care within our provider directory. This program highlights facilities and clinicians who consistently deliver outstanding specialty care and strong clinical outcomes. The initial designations focus on facilities with expertise in military sexual trauma. Additional specialty areas are planned for future expansion in other mental health specialties.

Providers who earn CoE status will receive:

  • A CoE badge displayed on their provider directory profile, increasing visibility and helping beneficiaries identify high-quality specialty mental health care
  • An informational pop-up on their profile explaining the designation and the criteria used to award it
  • Recognition for clinical excellence, safety, reliability, and adherence to specialty specific best practices

CoE Designation Criteria

To be considered for CoE status, providers must demonstrate excellence across three core areas:

  • Training: Facilities show that clinical staff have completed specialized training relevant to the population served and maintain competency in evidence‑based treatment approaches.
  • Quality: Facilities submit outcomes‑based performance data demonstrating meaningful clinical improvement, strong patient engagement, and positive satisfaction results, supported by measurement‑based care.
  • Trauma‑Informed Care: Organizations must have established trauma‑informed policies and procedures, routinely screen for trauma, and integrate practices that promote safety, empowerment, and patient voice throughout the care experience.

As the CoE program grows and expands, details will be added to this page on how a facility or provider may apply for consideration for CoE designation.