March 2025 Provider Pulse

TRICARE Primary Care Referral Approval Waiver Extended through April 30

The Defense Health Agency (DHA) has extended the temporary waiver for primary care referral approvals until April 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 April. For more details visit https://tricare.triwest.com.

Getting TRICARE beneficiaries the care they need is our top priority. We thank you for your commitment to serving TRICARE West Region beneficiaries.

CLRs Must be Submitted for Every Referral—Even During Waiver Period

Under the Department of Defense (DOD) TRICARE contract, providers are required to return Clear and Legible Reports (CLR) back to the primary care manager (PCM) on every referral.

CLRs must still be submitted during the current waiver period, even though there are no current authorizations. The waiver period ends on March 31, 2025. CLRs can be faxed back to the referring military medical treatment facility at the number provided on the beneficiary’s referral.

Providers should return CLRs for services rendered to active duty service members and Prime beneficiaries enrolled to a military hospital or clinic.

CLRs should be returned to the military hospital or clinic within 10 business days from the date of service for outpatient care. Inpatient discharge CLRs are due within 40 business days of discharge.

Outpatient CLRs should contain applicable information about the care provided such as:

• Specialty evaluations
• Lab and radiology reports
• Preventive services
• Clinical procedures
• Ancillary care
• Other clinical information obtained during the service

Inpatient CLRs should include:

• Consultation reports
• Operative reports
• Discharge summaries

For additional information see pages 27and 36 of the TRICARE West Region Provider Handbook.

NATO Data Fully Accessible in TriWest Systems

Clinics and medical providers who previously experienced issues accessing NATO beneficiaries’ eligibility and benefits data in their portals should be aware that this issue has been resolved.

NATO beneficiary information, including eligibility and benefits details, is fully available in TriWest systems. Thank you for your patience as we worked through this issue.

Empower TRICARE Beneficiaries to Quit Tobacco and Vaping

Helping TRICARE beneficiaries quit tobacco and vaping is key to improving their long-term health. The TRICARE West Region Tobacco and Vaping Cessation program provides resources to support individuals overcome nicotine dependence. When you refer a patient to our program, you help them lower the risk of serious health issues linked to smoking and vaping.

Our program connects patients with trained health coaches who provide step-by-step assistance to help them quit tobacco and vaping for good.

The program will feature webinars and peer-to-peer sessions. Both the webinars and peer-to-peer programs will be available later this year. These sessions will educate participants about the risks associated with smoking and vaping and emphasize tools that can aid in the journey to quit.

More information on these additional offerings is coming soon!

If you have TRICARE beneficiaries who would like to speak to a health coach about quitting tobacco and/or vaping, please have them contact the Tobacco and Vaping Cessation coach line at 833-818-2414.

TRICARE Provider Handbook Updates

A new section will be added to section 6.24 Fraud and Abuse to outline fraud and abuse in billing for services, supplies or equipment.