The U.S. Defense Health Agency has confirmed that the temporary waiver of referral and authorization requirements for TRICARE Prime beneficiaries in the West Region will end on June 30, 2025. Beginning July 1, 2025, all outpatient services for TRICARE Prime patients will once again require appropriate referrals and authorizations in accordance with standard TRICARE guidelines.

The waiver was initially enacted to ease administrative burdens during the transition of managed care responsibilities to TriWest Healthcare Alliance (TriWest), which assumed management of TRICARE West Region services on January 1, 2025. Under the waiver, providers did not need to submit referral or authorization requests for TRICARE Prime patients seeking TRICARE-covered outpatient services, with some exceptions.

Referrals for care that extends beyond June 30, 2025, will need to follow the prior established TRICARE referral and authorization requirements and obtain approval to continue care after June 30.  Referrals issued after June 30, 2025, will be subject to normal TRICARE referral and authorization requirements. 

Providers are strongly encouraged to review the TriWest TRICARE Provider Handbook and referral protocols to avoid disruptions in care or reimbursement issues starting July 1.

For More Information 

• CMA TRICARE Transition Guide: The California Medical Association (CMA) worked with TriWest to create a transition guide that answers commonly asked physician questions. The guide is free to CMA members.
• TriWest TRICARE Provider Handbook: The TriWest 2025 TRICARE West Region Provider Handbook provides an overview of the TRICARE program requirements, claims submission, eligibility, referrals and authorizations, and beneficiary out-of-pocket costs.
• TriWest TRICARE Provider webpage: Physicians with questions regarding the TRICARE transition should visit the new TriWest TRICARE Provider webpage or contact TriWest at providerservices@triwest.com or (888) 874-9378.