TRICARE Provider Contracting Q&A
Below, you'll find answers to the questions we get asked the most about on TRICARE Provider Contracting.
Q: When is the start of the next generation of TRICARE contracts?
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 is expected to start under T-5 on January 1, 2025. There will be a one-year transition period from the outgoing contractor to TriWest to help ensure a seamless experience for both providers and military families.
Q: When will TriWest start the contracting process for T-5?
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.
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 update your agreement to include you for participation in T-5, please retain a copy of this for your records;
- An amendment that requires your signature, which means you have to sign theT-5 amendment to your existing contract and return it to TriWest; or
- 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 VA’s rates. Details will be shared with you in the contract status communication in 2024.
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 program 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 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 www.tricare-east.com.
Q: While some services are covered for beneficiaries through TRICARE, what programs/specialties are excluded from provider contracting through TriWest as the TPA?
A: TriWest is not contracting for General Dentistry, Endodontics, Pharmacy, or Chiropractic for TRICARE. These services may be covered under TRICARE programs but not through TriWest. Additionally, beneficiaries eligible for both TRICARE and Medicare under TRICARE For Life can receive services through another contractor.
Q: How will care and existing authorizations transition from Health Net Federal Services to TriWest Healthcare Alliance for January 1, 2025?
A: Further clarification of how open authorizations issued under Health Net will transition to TriWest under the TRICARE program will be communicated in the coming months. Specific to case management, cases will start to transition to TriWest no earlier than 60 days prior to January 2025.