March 28, 2025 – 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.
Key Details on the Referral Authorization Waiver
- 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
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
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➡️ Source: Defense Health Agency Official Site
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