On January 1st, Tricare began offering healthcare under a new community contract. This means that the Triwest Healthcare Alliance is currently a contractor for the Tricare West region, including six states that have moved from the Eastern region. (Humara forces remain state contractors who stayed in the eastern region.)
The Defense Health Agency recognizes that beneficiaries in the western region have been experiencing challenges since January 1st. These include:
Payment Setup Call Center Weight Time Network Provider Introduction and Authorization Available Processing Triwest Beneficiary Portal Access
Together, DHA and Triwest are actively implementing strategies to address these concerns. The process is improving every day. The DHA understands that this period is important to maintain healthcare coverage. DHA is still committed to ensuring the best possible care for all beneficiaries.
“We took a series of actions to ensure that we were as insulated as possible from the negative effects of these performance issues,” said DHA Director Lieutenant General Territa Crossland, who announced that the Western Region on January 31st. I wrote this in a message to the beneficiaries. “We are working closely with Triwest to ensure we implement contractual requirements to meet our healthcare needs.”
It is important to know that this transition will ensure that beneficiaries have never lost Tricare coverage.
Read on to learn more about how DHA and Triwest are working to improve the experience of beneficiaries in the Western Region.
Do you live in the western region? You can call Triwest at 888-Triwest (874-9378).
The DHA recognizes that callers in the western region are experiencing important hold times and solutions. DHA has worked with Triwest to reduce wait times and get the answers you need.
Since January 1st, Triwest has hired over 400 customer service representatives. We have also added a callback function to reduce call waiting times. This feature is available especially during busy periods. If you select this option, you do not need to wait for hold. Triwest representatives will return calls in order.
Note: Resignation contractors – Health Net Federal Services, LLC, and Humana Military (six states that moved from the Eastern Region) can no longer support beneficiaries in the Western Region. Call your previous contractor to ask about a bill that includes a service date before January 1st. For all other questions, reach out to Triwest.
Do you use your bank's e-fund transfer, credit or debit card to pay Tricare coverage? You should provide Triwest with your recurring payment information now.
The DHA has extended payment deadlines for the Western Region. Currently, payment information must be provided until Friday, February 28th. If you have this may apply to you:
If you do not act before this date, you will be released retroactively to January 1st.
The easiest way to provide payment information is to use Triwest's secure beneficiary portal. Thousands of beneficiaries used the portal to submit payments.
It may take up to 48 hours to view your payment information in the portal. You can check your portal status and bank statement to see if your payment has passed. You can also take screenshots of these screens and save receipts to prove your payment.
Are you sure you need to provide payment info to Triwest? Check out the Tricare Newsroom article. Payment deadlines for beneficiaries in the western region have been extended. ” Visit www.tricare.mil/west to see your payment options.
Remember: This is not the case for you when you pay with a military pay system allocation. Payment for the assignment has been automatically transferred.
Triwest has experienced occasional suspensions of its safe beneficiary portals at the start of healthcare delivery, but recently made some portal improvements to enhance the beneficiary experience.
To create an account and manage your health information, you must use the same email that you find in the Defense Registration Eligibility Reporting System. Before you create an account, make sure your deer information is up to date.
Triwest has built a large provider network. Over 97% of the Western Regional Beneficiaries have access to all provider specializations. Triwest's network includes almost all of the Humana Military networks in six migration states. It also includes over 80% of providers that were in the HNFS network. Triwest will continue to load contract providers into the directory and actively expand the provider network to ensure access to care.
Check Triwest's Network Provider Directory to find a network provider near you.
Do you know any providers who are interested in joining Triwest's network? You must join the Triwest Healthcare Alliance Network.
Is Tricare Prime available? If so, you may have some questions about your active referral and approval.
Triwest is actively loading 2024 referrals and approvals into the portal. This means they are available to you and your provider. Many referrals and approvals are now available in the portal. More is added every day.
On January 25th, DHA announced it had waived the requirement to obtain approval for referrals to outpatient specialist care for Tricare Prime enrollees in the Western Region. This means that Tricare-approved specialist care providers do not have to wait for them to approve referrals issued by their primary care manager before providing outpatient care. However, before you take the specialist care, you will need to be referred by the PCM.
There are exceptions to certain services. The exemption will be introduced until March 31st and will be retroactive until January 1st. See “Defense Health Organization Announces Tricare West Region Referral Authorization Waiver” on TricareNewsroom.
Do you have undated referrals or approvals before January 1, 2025? Triwest accepts all unexpired referrals and approvals approved by previous contractors (Humana Military or HNFS). These will be accepted at the beginning of the expiration date or June 30, 2025. PCM does not need to take any additional actions to approve these again.
Have questions about referrals or approvals before January 1st? You need to call Triwest.
If your provider is not a Tricare network provider, you can continue to look at them and pay Tricare Prime Copayments. Starting April 1st, if the provider is still a non-network provider and is not named in referral or pre-authorized, you will need to pay a point-of-service fee. Make sure you get a new referral or pre-approval before the old one expires or by July 1st.
Keep a copy of all referrals and pre-certification if possible. This includes those from previous contractors.
DHA continues to monitor Triwest's operations and is committed to ensuring an effective transition for all Tricare beneficiaries. The beneficiaries appreciate the patience and cooperation during this transition period.
