TriWest TRICARE West Region Provider Handbook
Effective for Dates of Service Starting January 1, 2025
TRICARE Managed Care Support Contract (T-5 West) | Contract Number: HT940223C0002
Introduction to TriWest and TRICARE West Region
Welcome
Every day, health care providers in our communities are stepping up to care for military families. We thank these medical professionals for improving the lives of those we call heroes! On behalf of a grateful nation, we want every provider who has cared for the military or Veteran community to know – we are thankful for YOU.
This TRICARE Provider Handbook applies to the Department of Defense (DOD) TRICARE program for TriWest Healthcare Alliance (TriWest) network providers in the new 26-state TRICARE West Region. The West Region consists of the following states: Alaska, Arizona, Arkansas, California, Colorado, Hawaii, Idaho, Illinois, Iowa, Kansas, Louisiana, Minnesota, Missouri, Montana, Nebraska, New Mexico, Nevada, North Dakota, Oklahoma, Oregon, South Dakota, Texas, Utah, Washington, Wisconsin, and Wyoming. Note: For T-5, six states are moving from the TRICARE East Region to the West Region – Wisconsin, Illinois, Arkansas, Louisiana, Oklahoma, and Texas.
Health care delivery in the new West Region is scheduled to begin January 1, 2025. Throughout 2024, TriWest will work with current contractors and DOD for a seamless transition for patient care and provider experience.
To prepare for health care delivery in 2025, TriWest is now accepting interest forms from providers who wish to join the TriWest network. Beginning in the first quarter of 2024, TriWest will begin the process of notifying both future interested providers and current network providers about their contract status. It is expected that this process will take several months to complete.
TriWest is looking for providers who are motivated by our mission to provide quality health care to active duty military, their families, and Veterans. By joining our network, you can help make a difference in the lives of our nation’s heroes, doing Whatever It Takes!® to increase access to care for those who deserve it most.
About TriWest Healthcare Alliance
Since our founding in 1996, TriWest Healthcare Alliance has been On a Mission to Serve® our nation’s military and Veteran communities. TriWest previously administered the Department of Defense (DOD) TRICARE program in the West Region from 1996 to 2013.
TriWest is also the Department of Veterans Affairs (VA) third-party administrator for VA’s Community Care Network (CCN) in Regions 4 and 5, which includes the following 14 states: Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Texas, Utah, Washington, and Wyoming, along with the U.S. Territories in the Pacific Islands to include Guam, American Samoa, and Northern Mariana Islands. If you are not currently a CCN network provider and are interested in joining TriWest’s network to care for Veterans, visit JoinOurNetwork.TriWest.com. More details about CCN can be found in the online CCN Provider Handbook.
TriWest has a long history of superior customer service and dedication to doing what is right for our nation’s heroes and those who care for them. Doing Whatever It Takes!® not only is our corporate motto, it is a deep-rooted desire to go above and beyond for our customers, because we understand and honor them. We respect the military culture, we honor the sacrifices made, and we are committed to providing the service our customers deserve.
The health care providers in our network and our business partners strive to continually support the military and Veteran communities and exceed customer expectations. Together, we are one team making a difference in the lives of our nation’s heroes!
TRICARE West Region for Next Generation of TRICARE (T-5)
TRICARE is the Department of Defense’s (DOD) worldwide uniformed services health care program for active duty service members (ADSM), active duty family members (ADFM), National Guard and Reserve members and their families, retired Service members and their families, survivors, and certain former spouses. The Defense Health Agency (DHA) oversees the TRICARE program. TRICARE is managed by support contractors in two continental United States (CONUS) regions: TRICARE East and TRICARE West. DHA has contracted with TriWest as the support contractor for the new West Region.
The purpose of this contract is to provide Managed Care Support (MCS) to the DOD TRICARE program. For the West Region, TriWest assists the Military Health System (MHS) in operating an integrated health care delivery system combining resources of the military’s direct medical care system and our managed care support to provide health, medical, and administrative support services to TRICARE-eligible beneficiaries.
TRICARE Policy Resources
The Defense Health Agency (DHA) provides TriWest with guidance as issued by Department of Defense (DOD) for administering TRICARE-related services. DOD issues this direction through modifications to Title 32 of the Code of Federal Regulations (CFR), and TRICARE Manuals: TRICARE Operations Manual (TOM), TRICARE Reimbursement Manual (TRM), and TRICARE Policy Manual (TPM).
This TriWest TRICARE Provider Handbook provides an overview of the TRICARE program regulations and requirements. These manuals are regularly updated to reflect changes made to the TRICARE Program.
For current information about policy changes, timelines, and implementation guidance, refer to:
- TRICARE Manuals (TOM, TRM, TPM)
- TriWest’s provider training (specific link to be updated prior to start of health care delivery)
- TriWest’s secure provider portal (specific link to be updated prior to start of health care delivery)
- www.TriWest.com
DRAFT — pending DHA approval. Submitted for review on 2/15/24.
Disclosure Statement: The data in this handbook consists of TriWest Healthcare Alliance Corp (“TriWest”) Proprietary Information and is submitted with limited rights under DOD Contract No. HT940223C0002. The forms, methods, systems, procedures, trade secrets, technical data, and intellectual property TriWest utilizes in preparing and presenting this TriWest TRICARE Managed Care Support Contract (T-5 West) Provider Handbook are to remain the property of TriWest and are not, at any time, to be utilized, distributed or copied by Recipient, except as expressly authorized in writing by TriWest. Recipient agrees not to disclose the information contained herein except to its own employees and agents as necessary. Recipient covenants and agrees that its employees and agents will abide by this prohibition.