May 2025 Provider Pulse

TRICARE Primary Care Referral Approval Waiver Extended through June 30

The Defense Health Agency (DHA) has extended the temporary waiver for primary care referral approvals until June 30.

The waiver allows all TRICARE Prime enrollees referred for outpatient specialty care by their primary care manager to proceed without requiring a TriWest approval. Military beneficiaries enrolled to TRICARE Select do not require a referral for care, and TRICARE patients may continue to seek care from their existing care team, regardless of whether the provider has joined the TriWest network through the end of June. For more details visit https://tricare.triwest.com.

Prepare Now for July 1

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.

We Need Your Support! Help Keep the Provider Directory Accurate

To ensure TRICARE beneficiaries can get access to the care they need, it is essential that the West Region Provider Directory contains complete and accurate information for all TRICARE providers.

You can now make changes to your provider data through the directory link in Availity. Learn how to update your information by referencing the Provider Directory Change Request FAQ.

Online Referral and Authorization Submission Fastest Way to Care

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.

There are two ways to submit your referral and authorization requests via the provider portal in Availity.

1. Submit using the online referral management system available in the TRICARE West Payer Space in Availity. Under applications, look for “Submit Referral/Auth.”
2. If you’re experiencing issues with the online referral management system, complete the Alternative Referral and Authorization form also available in the Resources section of the TRICARE West Payer Space applications in Availity.

Don’t have an Availity account? It is simple to register for one.

Visit Availity to create your free account, enroll in training, and find other helpful resources. See How to Register as a New User Quick Reference Guide for details.

Once you’re in, you can complete the recommended training courses in Availity under “Help and Training” in the upper right corner including webinars, microlearning videos, and eSeminar learning paths.

For more information, check out the Introduction to the Provider Portal Quick Reference Guide.

What Requires Prior Authorization?

In the TRICARE West Region, authorizations are required for all procedures listed on the Prior Authorization List for all TRICARE beneficiaries.

For more information on referral and authorization guidelines visit the TRICARE Referral and Authorization Guidelines web page.

TRICARE Provider Handbook Updates

The following section will be added to outline marketing and advertising guidelines for providers.

Marketing and Advertising

Provider shall not (i) advertise the award of the Provider Network Agreement or the Program Terms and Conditions in such a manner as to state or imply that the Department of Defense (DOD) or Defense Health Agency (DHA) endorses a product, project, commercial line of endeavor, provider’s practice or services, or (ii) solicit, either directly or indirectly, the DHA, Defense Health Networks (DHNs) Military Treatment Facilities (MTF), or TRICARE beneficiaries through either provider’s commercial advertising or direct outreach. A TriWest network provider may only utilize the approved website badges on provider’s website as well as the approved print-ready signs found on TriWest's Proudly Caring for Military Families page to indicate their participating status in the TriWest network supporting TRICARE.

TriWest and the TriWest graphic logo are registered trademarks of TriWest Healthcare Alliance Corp. and may not be used in connection with provider's website, marketing, or publicity without prior written approval of TriWest. TRICARE is a registered trademark of the DOD, DHA. All rights reserved. Please see the TRICARE Trademark and Branding Program for further information on the DHA trademark use and branding requirements.