FAQs
We can work with any insurance carrier, the list below are plans we are most familiar with:
| Aetna | Blue Coss BlueShield | Humana |
| Medicare HMOs | Kempton | Amerigroup |
| Champus | Great West | Medicaid HMOs |
| TriCare | HealthCare Highway | Cigna |
| Guardian | HealthSmart | United Healthcare |
| Community Care | Coventry | Medicare |
| OHCA | Preferred Community Choice | Triwest |
| Global | OSMA | Multiplan |
| Integris Health Partners |
Currently, we have chosen to specialize in provider enrollment and credentialing services. This allows us to provide highly skilled support for your practice. We work with a few experienced billing companies that we are very comfortable sharing with our clients.
Currently, we have chosen to specialize in provider enrollment and credentialing services. This allows us to provide highly skilled support for your practice. We work with a few experienced billing companies that we are very comfortable sharing with our clients.
The completion for provider enrollment depends on many factors, including:
- Are you a new provider and enrolling for the first time
- Are you an established provider adding a new Tax ID or location
- Have you set up a CAQH number and access yet?
- Do you have an NPI?
- Do you have a Medicare number?
- How many plans are you enrollng in?
The choice to see patients prior to completing the enrollment process is your choice. However, one important thing to keep in mind is that you will have to bill your patients as a non-participating provider. This means the patient is subject out of network benefits or they may be responsible for up to 100% of your fee. The practice has to weigh the risks and benefits of taking this on for three to four months in some cases.
2025 TriWest Healthcare Alliance Contract
TriWest Healthcare Alliance replaced Humana Military as the contract that allows you to provide services for military members. This has been a very complex process; we thought it important to call it to your attention again in case you might have missed it before.
The main 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 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
You may also contact your account contact at Berkeley & Associates, and we will be glad to explain this transition.
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.
Berkeley Associates is celebrating 25 years as a results-driven credentialing company. We use our decades of experience to responsibly manage compliance issues like yours—as they occur. And, because we understand urgency, our associates are standing by to provide you the support you need when you need it most.
Our Credentialing Specialists work as a team to manage your credentialing and contracts, and place the highest premium on responsiveness and clear communication. We provide up-to-date status reporting via our proprietary credentialing software while contracting so you are always current and confident in your compliance.