Tricare West Suspends Referral Approvals Amid Contractor Transition Issues

Due to ongoing problems with the new West Region contractor, Tricare officials have paused the requirement that beneficiaries get referral approvals from TriWest before visiting experts.

"TriWest's referral system has had problems that have impacted the handling of new referrals," said Jacob Sanchez, a referral management expert for the Tricare Health Plan at the Defense Health Agency. "If you have Tricare Prime and live in the West Region, this waiver lets you use specialty services without any breaks in your care."

The waiver, valid from January 1 to March 31, lets Tricare West Prime beneficiaries see a specialist after getting a referral from their primary care manager without needing approval from a contractor. However, beneficiaries still need to get recommendations from their primary doctor.

TriWest will accept all referrals and authorizations from the former contractor, Health Net Federal Services, or Humana Military if they are dated before January 1. These referrals will be good until they expire or June 30, whichever happens first.

The switch to TriWest Healthcare Alliance at the start of the year has led to significant problems, raising worries from those who use the service and politicians. Patients and doctors have reported issues with getting recommendations, approvals, and access to medical care.

The Defense Health Agency is trying to fix these issues. The temporary waiver ensures Tricare West Prime beneficiaries can still get the necessary specialty care without delays.

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