A federal judge has ruled in favor of the U.S. Defense Health Agency (DHA) in a lawsuit filed by Health Net Federal Services (HNFS) over the agency’s decision to award the TRICARE West region managed care support contract to TriWest Healthcare Alliance.

This ruling now clears the way for TriWest to take over management of the Tricare West Region from HNFS by the beginning of 2025.

DHA initially awarded the new contract in December 2022, but HNFS immediately filed a series of protests with the Government Accountability Office. Although the protests were dismissed, HNFS then filed a lawsuit in federal court arguing that TriWest did not have an existing Tricare network in place and would face technical challenges that could disrupt patient care.

Under the new contract, TriWest will be the contractor that facilitates beneficiary health care in the civilian sector and provides administrative support services to Tricare beneficiaries throughout the 25-state western region, which includes California. (Six states will be shifting from the east region to the west region beginning in 2024 to balance to the TRICARE population each regional contractor manages.)

A timeline for completion of the turnover has not been formalized, but HNFS says it expects to provide services to Tricare beneficiaries through the end of the year. More information, including a provider contracting Q&A and provider contract request form can be found on the TriWest provider website. Per the Q&A, TriWest will begin outreach to future and current network providers about their contract status in the first quarter of 2024.

The California Medical Association will be closely monitoring the transition, is working with TriWest on a physician transition guide, and will provide more information as it becomes available.