On January 1, 2025, TriWest Healthcare Alliance (TriWest) began providing managed care services to TRICARE beneficiaries in the 26-state western region, including California. Due to challenges related to the transition of managed care responsibilities to the incoming contractor, the
U.S. Defense Health Agency has temporarily waived authorization and referral requirements for all outpatient TRICARE-covered services for TRICARE Prime beneficiaries in the West Region through March 31, 2025.  

During this time, providers will not need to submit referral or authorization requests for TRICARE Prime patients seeking TRICARE-covered outpatient services, with some exceptions. Authorizations and referral requests will still be required for inpatient care, applied behavior analysis, laboratory developed test and Extended Health Care Option services. 

According to the TRICARE West Region Referral Waiver Approval Letter, TRICARE Prime enrollees can obtain covered outpatient services from any TRICARE-authorized provider (network or non-network) during the waiver period without obtaining separate referral approval from TriWest.

Referrals issued by providers between January 1 and March 31, 2025, are valid for services rendered through June 30, 2025. Referrals for care that extends beyond June 30, 2025, will need to follow the prior established TRICARE referral and authorization requirements and obtain approval to continue care after June 30.  Referrals issued after March 31, 2025, must also follow TRICARE referral and authorization requirements.

Physicians with questions regarding the TRICARE transition should visit the new TriWest TRICARE Provider webpage or contact TriWest at providerservices@triwest.com or (888) 874-9378.

For More Information

• CMA TRICARE Transition Guide: The California Medical Association (CMA) worked with TriWest to create a transition guide that answers commonly asked physician questions. The guide is free to CMA members.
• TriWest TRICARE Provider Handbook: The TriWest 2025 TRICARE West Region Provider Handbook provides an overview of the TRICARE program requirements, claims submission, eligibility, referrals and authorizations, and beneficiary out-of-pocket costs.