Provider Pulse – October 2024
TriWest to Administer TRICARE Starting January 1, 2025
TriWest Healthcare Alliance (TriWest) will be administering TRICARE in the West Region starting Jan. 1, 2025.
Welcome letters are currently being sent to providers who are serving Veterans under the Department of Veterans Affairs (VA) Community Care Network (CCN) and are also contracted to deliver care under the Department of Defense (DOD) TRICARE network starting Jan. 1, 2025.
You can start to prepare now for TriWest’s launch on Jan. 1, 2025, in the following ways:
- Register for a free account on Availity.com. Availity is a platform where you can manage multiple health plans in one place. For TRICARE, TriWest will soon have a unique TRICARE Payer Space on Availity.
You can register for an Availity account on www.availity.com. If you need help with registration or have questions about your Availity account, call Availity at 800-282-4548. - Review the TriWest TRICARE West Region Provider Handbook. The TriWest TRICARE West Region Provider Handbook has information about program requirements, claims submission, eligibility, referrals and authorizations, and beneficiary out-of-pocket costs.
TRICARE At-A-Glance
- TRICARE is the DOD health benefit.
- TRICARE-eligible beneficiaries include enrolled active duty service members, active duty family members, National Guard and Reserve members and their families, military retirees and families, survivors and certain former spouses.
- The TRICARE West Region includes 26 states: Alaska, Arkansas, Arizona, California, Colorado, Hawaii, Idaho, Illinois, Iowa, Kansas, Louisiana, Minnesota, Missouri, Montana, Nebraska, Nevada, New Mexico, North Dakota, Oklahoma, Oregon, South Dakota, Texas, Utah, Washington, Wisconsin, and Wyoming.
- The DOD Defense Health Agency (DHA) has contracted with TriWest to assist TRICARE regional directors and military hospital commanders in operating an integrated health care delivery system in the new West Region.
- For the next generation of TRICARE, Humana Military will remain the regional contractor in the East Region. Six states will move from the East to the West: Arkansas, Illinois, Louisiana, Oklahoma, Texas, and Wisconsin.
Interested in joining the TriWest TRICARE West Region network? Get more information about TRICARE on TriWest’s Learn More About TRICARE web page.
Automatic EFT Enrollment for TRICARE Claims
TriWest is committed to processing and paying your claims faster and safer. To help with this, VA CCN providers who will now also care for military families under TRICARE will automatically be enrolled in Electronic Funds Transfer (EFT) for TRICARE claims. This change will speed up payments and lessen administrative burdens.
If you want to opt out of automatic enrollment, please send us the following information by Nov. 15, 2024:
- Provider name or office name
- State
- National Provider Identifier (NPI)
- Tax ID
How to Opt-Out:
- Email us at providerservices@triwest.com with the information above.
- Please use "EFT Opt-Out Request" in the subject line to help us categorize your request.
- Send your opt-out request to TriWest by Nov. 15, 2024.
Please note: If we do not receive your opt-out request by the deadline, you will automatically be enrolled in EFT for your TRICARE claims payments.
Have questions or need assistance? Contact our Provider Services team at providerservices@triwest.com, or call 877-226-8749 from 8 a.m. to 6 p.m. in your time zone.
Check a Veteran’s Eligibility Before Providing Care
Community Care Network (CCN) providers must have proof that a Veteran is eligible before giving care. Eligibility is confirmed by an approved referral/authorization from the Department of Veterans Affairs (VA). Once you have received VA’s approval, care can be given as described in the referral/authorization letter.
You can check the status of an approved referral using the VA’s HealthShare Referral Manager (HSRM) portal.
Urgent/Emergency Care Guidelines
Veteran eligibility must also be confirmed before providing care at an urgent care or retail walk-in clinic. A Veteran’s eligibility can be checked by calling 833-4VETNOW (833-483-8669).
At an emergency room, care should be provided to a Veteran who self-presents, and VA should be notified within 72 hours. Use VA’s Emergency Care Reporting portal or call 844-72HRVHA (844-724-7842).
Assignment of Benefits Required for VA CCN Claims
As a reminder, a Signature on File is required for any Veteran who receives care under the Department of Veterans Affairs (VA) Community Care Network (CCN). Starting in late October, TriWest will randomly select providers and conduct quarterly audits.
The Signature on File, also known as the Assignment of Benefits (AOB), shows that a claim may be submitted for the Veteran by the provider. The AOB also approves the payment of medical benefits to the provider.
What is an Assignment of Benefits?
An AOB is a document signed by the Veteran. It states that the provider will receive payment directly from the Veteran’s health plan third-party administrator. The Veteran is not involved in the payment process.
Providers must keep a signed AOB on file for each Veteran whose services are billed to a third-party administrator. The AOB must be saved for auditing purposes and updated at least annually.
How Will I Know I’m Selected for an Audit?
If you are selected for an audit, you will receive a letter with a list of Veterans from TriWest. Once you receive the letter, you will need to provide a copy of the AOB for each Veteran.
TriWest may also contact your office via phone to gather this information.
Providers must submit the AOB and any supporting documentation within 30 days of receiving a Request for Assignment of Benefits letter. Submit AOB documentation by:
- Email: CCNAOB@triwest.com
- Fax: 866-286-4177
- Mail:
TriWest Healthcare Alliance
Attn: CCN Claims - AOB
P.O. Box 42270
Phoenix, Arizona 85080-2270
Please note: If you prefer to send in an AOB via mail it must be received by TriWest within 30 days of the date the Request for Assignment of Benefits letter was sent.
If you have any questions, please contact our VA CCN Contact Center at 877-226-8749
What to Include in All Prescriptions for Veterans
Medication that is routine or medically necessary, is part of an authorized episode of care, and follows the rules of the VA National Formulary, is covered under the Department of Veterans Affairs (VA) Community Care Network (CCN). Medication that is needed on an urgent and/or emergent basis is also covered.
When submitting a prescription, VA requires that the following information is included for the provider:
- Name (Family, Given, Middle Suffix)
- National Provider Identifier (NPI)
- Tax ID Number (TIN)
- Personal DEA Number and expiration date (not a generic facility number)
- Office address
- Office phone and additional phone number
- Fax number (if applicable)
- Discipline (e.g., physician, physician assistant, nurse practitioner)
For more information, refer to the Pharmacy Services and Durable Medical Equipment section of the CCN Provider Handbook and the Pharmacy/Medication Process Quick Reference Guide.
VA CCN Provider Handbook Updates