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TriWest Healthcare Alliance
(TriWest) is contracted with the U.S. Department of
Defense for the administration of the TRICARE program
in the West Region. The TRICARE program is a health
entitlement program for active duty and retired members
of the military as well as their eligible dependents. TriWest
is an alliance of shareholder companies, including
Regence and other BlueCross and BlueShield Plans and
two large university health systems. TriWest
subcontracts panel development and maintenance activities
to TriWest shareholder companies, including Regence.
Asuris is also responsible for assisting and training
network providers. There are three TRICARE options
available for eligible beneficiaries: Standard, Extra,
and Prime.
- TRICARE Standard is similar to a traditional indemnity
plan with cost sharing and an annual deductible
- TRICARE Extra is similar to a preferred provider
organization (PPO)
- TRICARE Prime is similar to a health maintenance
organization (HMO)
For benefit information, please call 1 (888) TRIWEST
(874-9378).
Claims, billing and reimbursement
Hospitals are reimbursed according to TRICARE’s
diagnosis-related group (DRG) based payment methodology
and Medicare guidelines with the exception of sole
community hospitals which are reimbursed based on billed
charges. Physicians and ancillary providers are paid
according to a fee schedule called Champus Maximum
Allowable Charge (CMAC).
TriWest has partnered with Wisconsin Physicians Service
Insurance Corporation (WPS) to process and pay claims.
- For claims related questions, call 1
(888) 874-9378
- For Electronic
Data Interchange (EDI) related questions, 1 (800) 782-2680, option 2
View the TRICARE Program Manuals.
Prior Authorization
TriWest requires prior authorization for some services. View the current Prior Authorization List (PAL).
- Referrals (only required for members with
TRICARE Prime coverage)
When a primary care manager or specialist is unable
to provide a specialized medical service, he or she must
request a referral either from the local TRICARE
service center or TriWest.
Behavioral Health
TriWest’s Behavioral Health Portal is an online resource to help address the emotional needs of Service members and their families. The Portal offers access to several tools and resources including:
- Assessment tools
- Practice guidelines
- TRICARE benefit information
- Access to local and national resources
Credentialing
TriWest has specific credentialing standards that
are similar to commercial credentialing standards (e.g.,
National Committee for Quality Assurance [NCQA] or
the Utilization Review Accreditation Commission).
Providers applying for TRICARE must complete the supplemental credentialing questionnaire form per TriWest.
Use the Provider Information Update Form to notify us when:
- A provider leaves your clinic
- A new provider joins your clinic
- Your clinic/practice is no longer in business
- Your clinic/practice no longer accepts new TRICARE patients
- One of the following changes:
- Phone number
- Clinic/practice address
- Tax identification or National Provider Identifier number
Training
As a requirement of your contract, you or someone from your office must complete a TRICARE provider orientation within 120 days after joining the network.
New TRICARE providers and office staff new to TRICARE should take the TRICARE 101 webinar or eSeminar. New behavioral health providers and their staff new to TRICARE should take the TRICARE Behavioral Health 101 webinar or eSeminar. Learn more.
You may also
contact your provider
consultant to arrange an orientation in your office
or at a location near you.
Additional TRICARE resources:
Physicians and other health care professionals may
also contact their provider
consultant for
questions. TriWest beneficiaries should contact
TriWest directly at 1-888-TRIWEST (874-9378).
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