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FALLS CHURCH, Va. – The Defense Health Agency today announced three important extensions for TRICARE beneficiaries in the West Region.
• The referral approval waiver has been extended from March 31 to April 30.
• The point of service waiver has been extended from March 31 to April 30.
• The deadline to provide payment information to TriWest Healthcare Alliance, the new West Region contractor, has been extended to April 30.
The referral approval waiver allows TRICARE Prime beneficiaries to see TRICARE-authorized specialty providers for outpatient care without getting primary care manager (PCM) referrals approved by TriWest. However, beneficiaries still need their PCMs to provide referrals before getting specialty care.
This process is retroactive to Jan. 1.
TRICARE Prime beneficiaries may seek outpatient care from any TRICARE-authorized specialty provider with the following documentation:
• A copy of the referral dated Jan. 1-April 30.
• A copy of the TRICARE West Region Referral/Authorization Waiver Approval Letter, available on tricare.mil/west.
TRICARE Prime beneficiaries may see both network and non-network TRICARE-authorized providers during this waiver period. TRICARE Prime beneficiaries should ask the provider if they’re TRICARE-authorized.
The referral approval waiver does not apply to:
• Inpatient care
• Applied behavior analysis or Autism Care Demonstration services
• Laboratory developed tests
• Extended Care Health Option services
If beneficiaries need any of these services, TriWest will still need to approve their referral before they see a specialist.
The point of service waiver allows beneficiaries to continue seeing providers who may no longer be in network. However, providers MUST be TRICARE-authorized. This means they’re:
• Licensed by a state, accredited by national organization, or meet other standards of the medical community
• Certified to provide benefits under TRICARE
Beneficiaries using the point of service waiver will pay TRICARE Prime copayments.
Finally, beneficiaries enrolled in a TRICARE premium-based plan (TRICARE Young Adult, TRICARE Reserve Select, and TRICARE Retired Reserve) now have until April 30 to provide payment information to TriWest.
If beneficiaries have TRICARE Prime or TRICARE Select, they also have until April 30 to pay their fees.
If they don’t act before these dates, they’ll be disenrolled, retroactive to Jan. 1.
For more information, please visit the TRICARE Newsroom, or tricare.mil/west.
Media with additional questions should contact DHA Media Relations.
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The Defense Health Agency provides health services to 9.5 million beneficiaries, including uniformed service members, military retirees, and their families. The DHA operates one of the nation’s largest health plans, the TRICARE Health Plan, and manages a global network of more than 700 military hospitals, clinics, and dental facilities.
Defense Health Agency: dha.mil
Sign up for Military Health System e-mail updates at health.mil/subscriptions
| Date Taken: | 03.27.2025 |
| Date Posted: | 03.27.2025 16:31 |
| Story ID: | 493932 |
| Location: | US |
| Web Views: | 64 |
| Downloads: | 0 |
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