TRICARE July 2025 Provider Pulse

Avoid Balance Billing Your TRICARE Beneficiaries

Please be reminded that balance billing TRICARE beneficiaries is prohibited under the TRICARE West Region.

What is Balance Billing?

Balance billing occurs when a provider bills a TRICARE beneficiary for any amount exceeding the TRICARE-allowable charge after TRICARE has processed the claim.

A provider seeking any payment from a beneficiary, other than the applicable deductible and cost-sharing amounts for TRICARE/CHAMPUS-covered services may be in violation of federal billing regulations.

Noncompliance may impact your TRICARE and/or Medicare status. Balance billing requirements apply to both network and non-network providers who treat TRICARE beneficiaries. Both network and non-network providers are encouraged to explore all available options to resolve claims issues.

For more information, visit the TRICARE Balance Billing and Collection Activities section of the Provider Handbook.

Availity Account Required for TRICARE Referrals and Authorizations

We will soon be decommissioning the TRICARE West Region referral and authorization fax line (866-852-1893). To ensure continued care for your patients, you will need to join our provider portal on Availity if you haven’t already done so.

In addition to submitting your referral and authorization requests using the online referral management system or alternative referral and authorization form, there are several benefits of joining Availity, including:

• Determine if a referral or authorization is needed using the Referral and Authorization Decision Support (RADS) tool.
• Access the TriWest Learning Center.
• Submit claims and claim documents.
• Update your data in the provider directory.
• Find resources and quick reference guides.
• See key announcements to stay updated.

Get started in two easy steps:

1. Register – Visit Availity to create your free account, enroll in training, and find other helpful resources. To help walk you through this process, explore the How to Register as a New User Quick Reference Guide.
2. Complete recommended training courses on Availity under “Help and Training” in the upper, right corner. There are a variety of training types including:
1. Webinars – live, interactive virtual classes where providers can ask questions in real time.
2. Microlearning videos – short, bite-sized video snippets that cover various aspects of TRICARE.
3. eSeminar Learning Paths – Microlearning based on a variety of topics that, when viewed consecutively, form a complete eSeminar; think of microlearning as individual songs and the Learning Path as the playlist.

Once you’re logged in, check out the Introduction to the Provider Portal Quick Reference Guide.

Need additional registration assistance? Call Availity Client Services at 1-800-AVAILITY (282-4548) Monday through Friday 8 a.m. - 8 p.m. ET.

Check Unlimited Claims Online Through Availity

To get faster access to the information you need, use the online Availity Essentials tool to check claims status and other information. Claims status is always available to providers through Availity, and there is no limit to the number of claims you can review.

With just a few clicks, you can:

• View the status of unlimited claims.
• Filter your claims search by claim number, date, and more.
• Access detailed explanations of benefits and other information.

This self-service option is available 24/7 and helps ensure you get the information you need quickly.

Please note: When speaking with a customer service representative over the phone, assistance is limited to up to five claims per call.

Not using Availity? Here’s how to get started.

There are currently no updates to the TRICARE Provider Handbook.