TRICARE April 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.

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

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.

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

Simplify Your Referrals and Authorizations Process Using RADS

Availity’s online Referral/Authorization Decision Support (RADS) tool simplifies the referral and authorization submission and tracking processes.

Use the RADS tool to identify if healthcare services are a TRICARE benefit, require a primary care manager referral or require a prior authorization and medical necessity review. Providers can also submit referrals or authorizations for new care requests through Availity and ensure quicker processing times.

Need guidance on which services require referrals and authorizations? To access the tool:

• Log in to Availity.
• Navigate to the TRICARE West Payer Space.
• Click “Is a Referral/Auth Required?” under the Applications tab.

Enhancing Autism Care for Beneficiaries

Under TRICARE, the Autism Care Demonstration (ACD) provides specialized services for eligible beneficiaries with autism spectrum disorder (ASD). This program offers coverage for treatments such as Applied Behavioral Analysis (ABA) and other therapies.

To offer ABA services under the ACD, providers must:

1. Obtain a TRICARE certification.
2. Sign a Participation Agreement.
3. Undergo credentialing to join the network.

Provider status levels:

• Non-Network, participating provider: Requires TRICARE certification and signed Participation Agreement.
• In-Network, participating provider: Requires TRICARE certification, a signed Participation Agreement, a Network Agreement, and TriWest credentialing.

For more details, and to check eligibility status, visit the ACD web page.

TRICARE Provider Handbook Updates

There are currently no updates to the TRICARE Provider Handbook.