TRICARE March 2026 Provider Pulse

Learn More About Wellness Support for TRICARE Patients

Help beneficiaries take the next step towards better health by sharing resources provided by our wellness programs under Population Health and Disease Management:

• Pre-recorded Webinars: Allows TRICARE beneficiaries access to educational topics on demand.
• Wellness Webpage Campaigns: Refer beneficiaries to https://tricare.mil/west “Your Wellness Matters” for a variety of wellness topics including, TRICARE Skin Mission: Scan and Protect web page, and On a Mission to Heal: Navigating Posttraumatic Stress.
• Tobacco and Vaping Cessation (T&V) Line: Encourage beneficiaries to visit the TRICARE Tobacco and Vaping Cessation web page or call the T&V cessation line, 833-818-2414, for support to quit smoking or vaping.

TRICARE West Region patients can also refer themselves through the beneficiary portal for support for the following conditions:

• Anxiety
• Asthma (Pediatric and Adult)
• Coronary Artery Disease
• Chronic Obstructive Pulmonary Disease
• Congestive Heart Failure
• Depression
• Diabetes (Pediatric and Adult)
• Long-Covid
• PTSD

Unless indicated otherwise, disease management programs currently serve patients 18 years of age and older. Help us spread the word to beneficiaries by providing them with education and resources specifically made to lead a healthy life.

Do Not Balance Bill 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

The fastest and most efficient way to submit and view TRICARE West Region referrals and authorizations is through the secure provider portal, Availity. 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, there are several benefits of joining Availity. On Availity, you can:

• 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.

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.

Update to ACD Education Requirements

To remain compliant with Chapter 18, Section 3 of the TRICARE Operations Manual (TOM) requirements, all Autism Care Demonstration (ACD) providers shall complete the ACD Provider Education annually and retain evidence of attendance/completion of the latest published version. If the ABA provider fails to complete the ACD Provider Education by the final day of the calendar year, a 10% claims penalty for all ABA rendered services during the non-compliant period will be imposed.

The ACD Provider Education is offered as an on-demand, web-based module that can be accessed at any time for your convenience. To access the training:

• Log in to Availity.com.
• Go to the TRICARE West Payer Space.
• Click on the Access TriWest Leaning Center tile.
• Search “Annual Provider Training.”
• You can either enroll for a later training date or begin the training by clicking “Start Now.”

TRICARE Provider Handbook Updates

Please note that to align with Military Health System terminology, references to “behavioral health” will be changed to “mental health.”