March 28, 2025 | California, USA — MedLegalNews.com — TRICARE Referral Waiver: On January 1, 2025, TriWest Healthcare Alliance (TriWest) assumed managed care responsibilities for TRICARE beneficiaries in the 26-state western region, including California. However, due to challenges during this transition, the U.S. Defense Health Agency (DHA) temporarily waived referral and authorization requirements for TRICARE Prime beneficiaries seeking outpatient services.
This temporary waiver provides critical relief for TRICARE Prime beneficiaries who may face delays in accessing necessary outpatient care during the managed care transition. Healthcare providers are encouraged to review patient schedules and adjust referral processes to ensure timely treatment, as lapses in care could impact patient health outcomes. Beneficiaries should verify provider participation and coverage details to avoid unexpected out-of-pocket costs, emphasizing the importance of staying informed during this interim period.
Key Details on the Referral Authorization Waiver
The TRICARE referral waiver was introduced to prevent care disruptions during TriWest’s regional transition and to give both beneficiaries and providers time to adjust to the new managed care systems. Under this temporary policy, TRICARE Prime members can continue receiving essential outpatient services without waiting for authorization approvals—an effort designed to maintain continuity of care and minimize administrative backlogs.
- Waiver Period: Between January 1 and April 30, 2025, providers do not need to submit referrals or authorization requests for outpatient services.
- Covered Services: The waiver applies to all TRICARE-covered outpatient services for TRICARE Prime beneficiaries. Nevertheless, some exceptions still apply.
- Exceptions: Referral and authorization requests remain mandatory for:
- Inpatient care
- Applied behavior analysis
- Laboratory-developed tests
- Extended Health Care Option (ECHO) services
However, the Defense Health Agency emphasized that this waiver is a short-term measure. Providers are strongly advised to prepare for the reinstatement of standard referral requirements beginning May 1, 2025, to avoid claim denials or delays. The agency also recommends that medical offices track referral expiration dates carefully and communicate proactively with patients whose care may extend beyond the June 30 validity period.
For TRICARE beneficiaries in California and other western states, the waiver serves as a reminder of the importance of understanding network participation and referral timelines—especially as managed care contracts shift under TriWest’s administration.
Validity of Issued Referrals
- Referrals issued between January 1 and April 30, 2025, remain valid for services through June 30, 2025.
- However, referrals for care extending beyond June 30, 2025, must follow standard TRICARE referral and authorization procedures.
- Likewise, referrals issued after April 30, 2025, will also require authorization in line with TRICARE guidelines.
Provider Guidance and Contact Information
During the waiver period, TRICARE Prime enrollees can access outpatient services from any TRICARE-authorized provider, either network or non-network, without needing referral approval from TriWest.
Physicians with questions regarding the transition or referral policies can:
- Visit the TriWest TRICARE Provider Webpage
- Email: providerservices@triwest.com
- Call TriWest Provider Services at (888) 874-9378
Source: Defense Health Agency Official Site
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FAQs: About TRICARE Referral Waiver
What is the TRICARE referral waiver?
The TRICARE referral waiver temporarily allows TRICARE Prime beneficiaries to receive outpatient services without needing referral or prior authorization during the transition period.
When is the TRICARE referral waiver effective?
The waiver applies from January 1 through April 30, 2025, with referrals issued during this period valid for services through June 30, 2025.
Which services are excluded from the TRICARE referral waiver?
Inpatient care, applied behavior analysis, laboratory-developed tests, and Extended Health Care Option (ECHO) services still require standard referrals and authorizations.
How can providers get guidance on the TRICARE referral waiver?
Providers can visit the TriWest TRICARE Provider Webpage, email providerservices@triwest.com or call (888) 874-9378 for assistance during the waiver period.