Understanding the TriWest Healthcare Alliance Transition and NDAA Section 714: For Members & Beneficiaries of our Armed Forces

One of the most common concerns surrounding the TRICARE West transition is the potential for disruptions in care. While transitions of this scale are complex, TriWest’s leadership has emphasized their commitment to minimizing challenges and ensuring continuity of care. For instance, an expedited credentialing process is in place, and many providers are already in various stages of joining the network. Surveys of providers (the majority located in Colorado) indicated that 75% of providers have initiated the credentialing process, and 17% have completed it with executed contracts.
 
Moreover, the provider capacity analysis highlights that many credentialed providers are prepared to accept new clients. These proactive efforts, combined with operational efficiencies such as a 99% claims processing accuracy rate and a three-day average turnaround time for payments, indicate a solid framework for meeting the needs of TRICARE beneficiaries.
 
Supporting Providers and Beneficiaries
Beneficiaries 
Important Information for TRICARE Patients Regarding Provider Network Changes
 
For TRICARE Prime Enrollees
If your provider is a TRICARE network provider: 

• You can keep seeing your provider until the referral ends or June 30, 2025, whichever comes first. TRICARE Prime copayments apply.

If provider is no longer a TRICARE network provider:

• You can keep seeing your provider and pay TRICARE Prime copayments apply.
  
• You can keep seeing your provider and pay TRICARE Prime copayments until April 1, 2025. Starting April 2, 2025, if the provider is still a non-network provider, you'll have to pay point-of-service fees. You may also have to pay up front and file a claim when seeing a nonparticipating, non-network provide.

For Care Not Requiring Pre-Authorization
Patients may keep seeing their provider and pay TRICARE Prime copayments. Starting April 2, 2025, if the provider is still a non-network provider, they patient may have to pay point-of-service fees and file a claim when seeing a nonparticipating, non-network provider.
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For TRICARE Select Enrollees
Starting January 1, 2025
If your provider is a TRICARE network provider:

• You can keep seeing your provider until the preauthorization ends or June 30, 2025, whichever comes first.

If your provider is no longer a TRICARE network provider:

• You can keep seeing your provider but you’ll pay a non-network copayment/deductible/cost-share. To avoid higher costs, ask for a new pre-authorization to a TRICARE network provider.
  

 
For Care Not Requiring Pre-Authorization
Starting Jan. 1, 2025, make sure to see a TRICARE network provider. If you don’t, you’ll pay more out-of-pocket. You may also have to pay up front and file a claim when seeing a nonparticipating, non-network provider.

 
**Point-of-Service (POS) option allows TRICARE Prime beneficiaries to receive nonemergency care from any TRICARE-authorized provider without a referral from their Primary Care Manager (PCM). While this offers greater flexibility in choosing healthcare providers, it comes with higher out-of-pocket costs.
Key aspects of the POS option include:

• Annual Deductible: Before TRICARE shares the cost, you must pay a deductible of.
• Cost-Share: After meeting the deductible, you're responsible for 50% of the TRICARE-allowable charge for the services received. 
• Exclusions: POS costs don't count toward your annual catastrophic cap—the maximum.

Situations where the POS option doesn't apply:

• Active duty service members cannot use the POS option.
• If you have a referral from your PCM, standard TRICARE Prime costs apply.
• Emergency care and preventive services from network providers don't fall under the POS option.**

For TRICARE Select Enrollees
If Your Pre-Authorization Extends Past January 1, 2025:
If your provider remains in the TRICARE network, you can continue care until the pre-authorization expires or June 30, 2025, whichever comes first.  
 
If your provider is no longer in the network:  

• You may still see them, but out-of-pocket costs will increase.
• You’ll need to pay a non-network copayment or cost-share, which is higher than in-network costs.  

 
For Care That Does Not Require Pre-Authorization:

• Starting January 1, 2025, using TRICARE network providers will help you avoid higher out-of-pocket costs.  
• If you see a nonparticipating/non-network provider, you may have to pay upfront and submit your own claims.  

 
What You Can Do Next:
1. Check your provider’s network status: Contact your provider or TRICARE to confirm if your provider is in the network.  
2. Request a new referral or pre-authorization if needed: This ensures continuity of care and minimizes your costs.  
3. Consider switching to a TRICARE network provider:  If your provider is no longer in the network, this can help you avoid higher fees.  
 
We encourage you to plan ahead to ensure uninterrupted care and avoid unexpected costs.

**This information does not apply to Active Duty service members, who have a different process in pursuing care**

Providers
TriWest has outlined clear pathways for providers to join the network and access support resources. Providers can visit the TRICARE West website, complete the "Join Our Network" form, and submit credentialing documentation once requested. Claims submission processes—both electronic and by mail—have also been streamlined to reduce administrative burdens. TriWest has stated that they are working to credential providers that were already in network and serving military families as a priority.  
 
For beneficiaries, understanding these processes is key to navigating the transition smoothly. Tools such as TriWest’s online portal offer resources for managing claims, checking real-time statuses, and enrolling in electronic funds transfer. Additionally, regular updates to provider directories and the continuation of existing referrals through June 30, 2025, aim to maintain care continuity during the transition period; please see the Prime and Select.

For more provider information, please read "Understanding the TriWest Healthcare Alliance Transition and NDAA Section 714: A Comprehensive Guide for Mental Health Providers Serving Military Communities".

 
The Role of NDAA Section 714
The implementation of Section 714 of the FY25 NDAA marks a significant advancement in military healthcare. This provision would allow military members and their families to retain their TRICARE medical providers for telehealth/teletherapy services, regardless of their station or deployment location. It ensures continuity of care across duty station changes and expands access to critical services.
 
According to the provision, the Department of Defense will have to develop and release interim final regulations to implement Sec. 714 in 180-days. Stakeholders, including providers and beneficiaries, are also encouraged to participate in discussions and share feedback to shape the policy effectively. TriWest and Humana are collaborating to develop implementation details for the Department’s consideration.
 
Advocacy and Collaboration
A hallmark of this transition has been TriWest’s willingness to engage in dialogue and respond to feedback from providers and beneficiaries. During a recent discussion with TriWest leadership, their openness to input and acknowledgment of the unique challenges faced by clinicians and military families stood out. Such collaborative efforts are vital to addressing concerns and ensuring a successful transition.
 
Equally important is the role of the community in shaping the future of military healthcare. Providers can contribute by completing the network joining process, staying informed about policy developments, and participating in feedback opportunities. Beneficiaries can play their part by advocating for their needs and sharing accurate information within their networks.
 
Moving Forward Together
The transition to TriWest and the implementation of Section 714 represent important milestones in military healthcare. While challenges are inevitable, proactive efforts by TriWest, combined with community engagement, provide a strong foundation for success. Together, we can ensure that service members, veterans, and their families receive the exceptional care they deserve with minimal disruption.
 
Let’s approach this transition with patience, collaboration, and a shared commitment to improving our healthcare system. By working together, we can navigate these changes and build a stronger future for military healthcare that meets the needs of our community. 
 
 
Author: Dr. Courtney Barber, PsyD, LMFT, AAMFT-S        
 
Web Resources
10 USC 1094: Licensure requirements for health-care professionals
H.R.5009- Servicemember Quality of Life Improvement and National Defense Authorization Act for Fiscal Yar 2025
Tricare.mil