November 2025 Provider Pulse

TRICARE Open Season: What You Should Know

Open Season is a critical time for eligible TRICARE beneficiaries to make enrollment decisions that take effect the following year. For providers, this could mean an increased chance of plan changes, and potential impacts on network status, referrals, claims and authorizations.

TRICARE Open Season is the annual enrollment period where eligible beneficiaries can enroll in, change, or disenroll from certain TRICARE health plans for the upcoming year. For 2025, the Open Season runs November 10 – December 9.

Open Season applies to beneficiaries enrolled in or eligible for TRICARE Prime and TRICARE Select. It does not apply to:

• Active duty service members (their coverage does not change during Open Season)
• TRICARE For Life
• Premium-based plans (TRICARE Reserve Select, TRICARE Retired Reserve, TRICARE Young Adult)

If a beneficiary who is eligible for Open Season does not make a change and is enrolled in a plan, their plan will carry over. If they’re not enrolled and eligible, but take no action, they may only receive care at a military hospital/clinic when space is available.

For more information visit the Beneficiary Open Season Frequently Asked Questions for Providers QRG.

Submit ADT Notifications Without Delay

Timely admission, discharge, and transfer (ADT) notifications play an important role in ensuring care is coordinated properly, reviewed for medical necessity, and aligned with authorization and claims requirements.

When a TRICARE beneficiary is admitted, discharged, or transferred, TriWest Healthcare Alliance (TriWest) and the Defense Health Agency (DHA) use this information to:

• Verify authorization and network status
• Ensure a safe transition to home, and provide appropriate discharge follow-up
• Coordinate transitions of care
• Support utilization review and continuity of treatment
• Prevent gaps in documentation or billing delays

Without prompt notification, claims processing and ongoing care coordination may be delayed, or a beneficiary may end up back in the hospital.

What should providers do:

• Promptly report ADTs. Notify TriWest as soon as possible after a TRICARE beneficiary is admitted, discharged, or transferred.
• Include complete patient information and available clinical details. Submit the beneficiary’s name, DOD benefits number, facility name, dates of service, admitting and attending providers, and relevant diagnoses or procedures.
• Use the correct channels. Submit ADT notifications through one of the following channels:
  • Directly upload authorization on Availity.com (TriWest provider portal)
  • Fax to 1-866-852-1885
• Confirm receipt. Keep documentation showing that the notification was sent and received. This can help resolve questions during claims or retrospective reviews.

For more information see the Medical Management section of the TRICARE West Region Provider Handbook.

Reminder: Certification Required for TRICARE ABA Providers

Please be reminded that to become a TRICARE applied behavioral analysis (ABA) provider, you must sign a Participation Agreement and be TRICARE certified.

TriWest will certify ABA providers for TRICARE within 10 business days from the receipt of a complete application that meets all certification requirements. Once the certification process is complete, you will be notified by TriWest’s certification team. Please note that there is also a process for credentialing to become a TRICARE network provider.

For more information about the Autism Care Demonstration (ACD) and certifications, please reference the TRICARE West Region ACD web page.

TRICARE Provider Handbook Updates

There are currently no updates to the TRICARE Provider Handbook.