TriWest Healthcare Alliance Contract
As your contracting partner, the team of Berkeley Associates have put together a FAQ as a synopsis of the TriWest Healthcare transition from Humana Military. On January 1, of 2025 TriWest Healthcare Alliance officially replaced Humana Military as the military provider. That means this is now the contract that allows you to provide services for military members. As you might guess, this has been a very complex process, which has left many of our providers wondering exactly what this means for them. We understand. That is why we are posting this information here; to present the necessary info as clearly as possible, so that you know exactly what this means for you.
The primary things to know:
- If you were contracted (in-network) with Humana Military, you don’t need to do anything. That contract is automatically assigned to you. While there is a delay in loading, TriWest will honor this at least through the month of January for contracted providers.
- It you were non-network (certified provider) under Humana Military, you should have received a contract in the mail, which was to have been signed and sent to TriWest Healthcare Alliance.
- If you are unsure of your contract status, feel free to contact your representative at Berkeley & Associates. We are here to help.
Q: When is the start of the TriWest Healthcare Alliance?
A: The first date of service for claims under TriWest Healthcare Alliance is January 1, 2025. For background, in December 2022, the Department of Defense (DOD) awarded the TriWest Healthcare Alliance (TriWest) the contract to administer its next generation TRICARE West Region contract, commonly referred to as “T-5.” Health care delivery for T-5 with start for dates of service on or after January 1, 2025. A one-year transition period from January 1, 2024 was carried out until January 1, 2025, to ensure a seamless experience for providers and military families.
Q: What kind of contract will my organization receive?
A: There are two types of contract status changes you might receive:
- If you were already a network provider, you received an auto-amendment to your contract, which does not require any action by you to participate in T-5; please retain a copy of this for your records.
- If you were a non-network certified provider, you should have received a new contract in the mail. You were not previously a network provider with TriWest, so they required a new signed contract. This should have been returned to TriWest to join the network. If you were not “network contracted” in the past and have not signed a new agreement, you are considered out of network as of January 1, 2025.
Q: What will the new TRICARE reimbursement rates be?
A: Reimbursement rates will differ from past DOD TRICARE rates and differ from Department of Veterans Affairs (VA) rates. Details will be shared with you in the contract status communication in 2024. For reference, most reimbursement is based upon this data:
CHAMPUS Maximum Allowable Charge (CMAC) rates
Q: Who do I contact if I have more questions about TRICARE contracting with TriWest?
A: TriWest has provided online links and phone contact information. They are available to answer questions about the new T-5 contract and how it will work. You may contact TriWest at providerservices@triwest.com or feel free to visit www.triwest.com. Berkeley & Associates are happy to take your questions, and assist as much as we are able to.
Q: What if I have questions about or need help with this online form for interested providers?
A: Please contact TriWest:
providerservices@triwest.com or call 1-866-690-0885
We are here to help
You may also contact your account contact at Berkeley & Associates, and we will be glad to help with this transition and share everything that we know about this.
If you have returned the signed contract to TriWest already, please notify your contact at Berkeley & Associates so that we can put that in your contract file.
This is a summary explanation of the transition, below are links that answer your questions in more detail. I encourage you or someone in your practice read through this information, which will most likely answer any questions you might have about the details of the transition.
https://tricare.triwest.com/en/provider/join-our-network/tricare-provider-contracting-q–a/
https://tricare.triwest.com/en/provider/top-5-things-to-know/
