TRICARE® West Region Transition: What You Need to Know About Referrals and Authorizations
Wednesday, October 16, 2024
Health care delivery under new TRICARE contracts starts on Jan. 1, 2025. This change will affect you and your TRICARE patients (except those enrolled in TRICARE For Life, the US Family Health Plan, or a TRICARE health plan overseas). In the TRICARE West Region, the regional contractor will change from Health Net Federal Services, LLC (HNFS) to TriWest Healthcare Alliance (TriWest). How your TRICARE patients get care won’t change for the rest of 2024. But you might have questions about what happens with referrals or authorizations that expire after Dec. 31, 2024. Learn more about what to expect.
Through Dec. 31, 2024
Continue to submit referral and pre-authorization requests to HNFS. We are responsible for managing care through the remainder of our contract. Be sure to submit all clinical information necessary for HNFS to complete our review. We may cancel requests received in late December that are missing required clinical documentation and ask that you resubmit to TriWest. We will transfer any requests that are pending at the close of our contract to TriWest as appropriate.
Beginning Jan. 1, 2025
TriWest will be the new West Region regional contractor and will be responsible for managing care that is received on or after Jan. 1.
- TriWest will accept unexpired referrals and pre-authorizations from HNFS that were issued prior to Jan. 1, 2025. These will be valid through their expiration or June 30, 2025, whichever comes first.
- For your patients enrolled in TRICARE’s Autism Care Demonstration (ACD), TriWest will accept ACD referrals and pre-authorizations from HNFS that began prior to Jan. 1, 2025, through their expiration date.
Want more information about the transition? We offer answers to frequently asked questions at www.tricare-west.com/go/transition-out. You also can visit www.tricare.mil/changes.
