TriWest Healthcare Alliance, the new contractor for Tricare’s West Region, took over operation of the military’s health plan on January 1, 2025.
It’s been nothing but a complete SNAFU…!
The previous contractor, HealthNet Federal Services, will only have their customer service lines staffed through March 30, 2025. And they’ll only accept 2024 claims through April 30th, 2025.
So, get busy if you still have 2024 claims to resolve!
Here’s a link to a Tricare West transition quick reference guide that might come in handy.
As before, outpatient mental health doesn’t require prior authorization except in the case of active-duty service members.
Here’s a complete list of services requiring Tricare prior authorization. There are other mental health services on here – so if you provide something other than counseling, take a look!
If you’re still not clear, there’s a decision tool you can use to determine if a referral or prior authorization is required.
If you were participating in 2024 but never received a contract for 2025, sign up here to join TriWest Healthcare Alliance. Many Tricare providers apparently didn’t receive new contracts. Or, contracts that were sent in were never processed – I’m working on a few of those right now!
On Jan. 31, the Director of the Defense Health Agency issued a letter to beneficiaries. (Click here to download a copy).
DHA has issued a waiver to allow clients who saw Tricare participating providers in 2024 to continue at the in-network level through March 31, 2025, even if their therapist’s new contract with TriWest hasn’t been fully finalized.
Keep this letter handy in case of claims issues!
Speaking of claims issues: While some clinicians are slowly receiving a few payments, others are dead in the water. I know of several who have waited 5+ weeks just to have electronic claims enrollment approved.
Finally, let your clients know to change their autopayment to TriWest to pay their premiums – or they won’t have ANY coverage!
It’s not much better in the East Region, apparently…
Although Humana Military retained the Tricare East contract, they switched claims processors. Tricare is a complex beast – Humana is the East Region contract administrator, but their claims are actually outsourced. Prior to this year, Humana was using Wisconsin Physicians Services (WPS), but switched in 2025 to Palmetto Government Benefits (PGBA).
If these names sound familiar, it’s because PGBA is the Medicare contractor for Alabama, Georgia, North & South Carolina, Tennessee, Virginia & West Virginia. And WPS handles Medicare in the Midwest: Indiana, Iowa, Kansas, Michigan, Missouri & Nebraska.
So this might be a big part of the problem: TriWest Healthcare Alliance, the West Region contractor, ALSO outsources to PGBA for claims. So PGBA might be a little, um, overloaded at the moment.
Government healthcare contracting has shuffled around the same contractors for decades in a weird game of musical chairs, but this year, it seems like PGBA grabbed all the chairs and now its room might be too crowded.
See below for more government contracting news on the horizon…
For all Tricare clinicians, East or West:
There are a lot of different Tricare plans! Did you know you can find out the benefits for all plans without having to make a phone call? Click here.
Scroll down a bit to where it says choose a plan. Click on the plan type your client has. On the next page, the first few sections apply to clients and give enrollment criteria. Skip down to the section entitled What you Payand then click on View [plan name] costs. The page you’re taken to will have the 2025 deductibles, copayments, and cost-shares, with links back to 2024 in case you still need that information. Although these websites are primarily meant for clients, it’s useful information for you as well – because you can get accurate benefits without waiting on hold!
Has your Tricare contract reduced the allowable rates set by the government?! Here’s how to find out!
And if the Tricare contract shuffle isn’t bad enough…
In some states, Medicare contracts will be up for renewal in 2025!
If you’re in Indiana or Michigan, watch out! WPS Medicare’s J8 contract ends October 2025.
And for the very large region of Jurisdiction F (Alaska, Arizona, Idaho, Montana, North Dakota, Oregon, South Dakota, Utah, Washington, & Wyoming), Noridian’s current contract is set to expire this July.
As of yet, there have been no decisions on contract extensions or awards for either J8 or JF.
All in all, 2025 promises to be another turbulent year. Right where 2024 left off.
