TRICARE Provider Contracting Q&A
Below you’ll find answers to the frequently asked questions regarding TRICARE Provider Contracting.
Q: When is the start of the next generation of TRICARE contracts?
The first date of service for claims under the next generation of TRICARE contracts is January 1, 2025. For background, in December 2022, the Department of Defense (DOD) awarded TriWest Healthcare Alliance (TriWest) the contract to administer its next generation TRICARE West Region contract, commonly referred to as “T-5.” Health care delivery for T-5 will start for dates of service on or after January 1, 2025. A one-year transition period (from January 1, 2024) continues until January 1, 2025, to ensure a seamless experience for providers and military families.
Q: When did TriWest start the contracting process for T-5?
To prepare for health care delivery in 2025, TriWest is accepting interest forms from providers who wish to join the TriWest network. Beginning in the first quarter of 2024, TriWest started notifying future interested providers and current network providers about their contract status. It is expected that this process will take several months to complete. Providers should receive copies of executed agreements by the end of 2024.
Q: What kind of contract will my organization receive?
There are three types of contract status changes you might receive:
- An auto-amendment to your contract, which does not require any action by you to participate in T-5; please retain a copy of this for your records.
- An amendment that requires your signature, which means you have to sign the T-5 amendment to your existing contract and return it to TriWest.
- A new contract, which means you were not previously a network provider with TriWest, so you have to sign a full contract and return it to us in order to join the network.
Q: What will the new TRICARE reimbursement rates be?
Reimbursement rates will differ from past DOD TRICARE rates and differ from Department of Veterans Affairs (VA) rates. Details will be shared with you in the contract status communication in 2024. For reference, most reimbursement is based upon CHAMPUS Maximum Allowable Charge (CMAC) rates.
Q: Who do I contact if I have more questions about TRICARE contracting with TriWest?
We are happy to answer further questions about the new T-5 contract and how it will work. You may contact TriWest at providerservices@triwest.com or please feel free to visit www.triwest.com.
Q: What if I have questions about or need help with this online form for interested providers?
Please email TriWest at providerservices@triwest.com or call 1-866-690-0885.
Q: I am interested in joining the TRICARE East Region network. How do I do that if TriWest is only covering the TRICARE West Region?
A: If you are inquiring about TRICARE for the East Region, please contact Humana Military East Region at 1-800-444-5445 or visit www.tricare-east.com.
Q: I am a provider in the TRICARE East Region with Humana Military, and I have heard my contract is moving to TriWest in January, what does this mean?
A: All provider agreements supporting TRICARE under Humana for the states transitioning to the TRICARE West Region will be assigned to TriWest with an effective date of January 1, 2025. This means that TriWest will become a party to the contract, replacing Humana, for all care delivered on and after that date. Communication has been sent to impacted providers. No further action is needed currently. TriWest is still in the process of loading data and will have the information ready at the start of health care delivery on January 1, 2025. Make sure your contact information (phone number, mailing address, etc.) is updated with the current health care administrator.
The six states moving from the East Region to the West Region with dates of service starting on or after January 1, 2025, are:
- Arkansas
- Illinois
- Louisiana
- Oklahoma
- Texas
- Wisconsin
Q: While some services are covered for beneficiaries through TRICARE, what programs/specialties are excluded from provider contracting through TriWest as the third party administrator (TPA)?
A: TriWest is not contracting for General Dentistry, Endodontics, Pharmacy, or Chiropractic for TRICARE. These services may be covered under other TRICARE programs or contractors but not through TriWest. Beneficiaries eligible for both TRICARE and Medicare under TRICARE For Life can receive services through another contractor.
Q: Where can I go for additional information about TRICARE’s transition to TriWest?
A: Please visit the Military Health System’s contract transition page for more information.
Q: Will referrals and authorizations currently in place transfer from the current contractor to TriWest?
A: TriWest will accept unexpired referrals and pre-authorizations from Health Net Federal Services that were issued prior to Jan. 1, 2025. These will be valid through their expiration or June 30, 2025, whichever comes first. TriWest will also accept valid referrals and pre-authorizations from Humana Military if you the beneficiary lives in a state moving to the new West Region. These states are Arkansas, Illinois, Louisiana, Oklahoma, Texas, and Wisconsin. These will be valid through their expiration or June 30, 2025, whichever comes first.
Q: Now that my contract is complete, what do I need to do to prepare for the January 1, 2025, TriWest transition?
A: Great question! You can prepare in the following ways:
- Register for a free account on Availity.com. Availity is an online platform where you can manage multiple health plans you accept in one place. TriWest uses Availity as its secure provider portal. For TRICARE, TriWest will have a unique TRICARE Payer Space on Availity where you will be able to:
- Submit claims and check claims status
- Access authorizations
- Manage your demographic information (such as address and phone number)
- Find tools and resources like the Provider Handbook, Quick Reference Guides, and more
- Take training on TRICARE processes and procedures
If you don’t already have an account on Availity, register now at www.availity.com.
If you need help with registration or have questions about your Availity account, call Availity at 1-800-282-4548.
- Review the TriWest TRICARE West Region Provider Handbook. It contains information about program requirements, claims submission, eligibility, referrals and authorizations, and beneficiary out-of-pocket costs.