Have you registered Tricare Prime? You should know that the Defense Health Agency has renounced the obligation to obtain the pre-authorization of references to specialized ambulatory care for registrants of Tricare Prime in the West region. This means that specialized care providers authorized in Tricare do not need to wait Triwest To approve the references issued by your Primary care manager Before providing ambulatory care. However, You will always have to obtain a reference from your primary care manager Before receiving this specialized care.
This process will be in place March 31 and is retroactive on January 1, 2025.
“Triwest’s reference portal has experienced problems that affected the processing of new references,” said Jacob Sanchez, reference management expert, Tricare Health Plan, to DHA. “If you have Tricare Prime and you are in the West region, this derogation will allow you to access specialized services without interruption of your care.”
This renunciation does not apply to:
If you need one of these four above services, Triwest will always have to prevent your reference before seeing your specialist.
During this period of renunciation, you must follow the rules of your Tricare Prime plan, as described in the Tricare Choices in the United States Handbook. You can continue to see your PCM to obtain references for specialized care – even if your PCM is not currently Triwest network.
So what’s different?
- Until March 31, you don’t have to wait for Triwest to deal with your reference to request care. You should ask your PCM a copy of your reference.
- You can ask your PCM to recommend a local Tricare specialist. You can also see a specialist you have seen before, if they are a supplier authorized by Tricare. You can also search Triwest supplier directory To find specialists in your region.
- When you see your specialist, bring the copy of your reference, dated January 1 to March 31. You can also bring a copy of the letter of approval for approval from the Tricare West region, available on www.tricare.mil/west.
Note: If you see a civilian PCM, they may also be able to send your reference to your electronic specialist. But you have to ask and keep a copy for your files.
The process of obtaining specialized care within a military hospital or a clinic has not changed.
You do not know if your PCM or your specialist is in the Tricare network? If your supplier is no longer a Tricare network supplierYou can continue to see them and pay Tricare Prime copaia. However, they must be authorized by Tricare. This means they are:
- Licensed by a state, accredited by the national organization, or comply with other standards of the medical community
- Certified to provide advantages under Tricare
They don’t have to be in the Tricare network, but be sure to ask the supplier if they are authorized by Tricare before receiving care.
From April 1, if the supplier is still a Birth supplier And is not appointed to your pre -authorization, you will have to pay Service point costs.
From April 1, you will need a reference to your PCM approved by Triwest to see a specialist.
Do you have a benchmark or an unpaid authorization dated before January 1, 2025? Triwest will accept all the not expired references and authorizations approved by the previous entrepreneur (Humana Military or HNFS). These will be accepted by their expiration date, or on June 30, 2025, according to the first possibility. Your PCM does not need to take additional measures to have them approved again.
Do you have questions about references, authorizations or other parts of the western region? Check Transition from the West West region To learn who to contact with your questions.
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