MAY 1, 2025 – Do you live in the West Region? Do you have TRICARE Prime? You should know that the Defense Health Agency has extended the West Region referral approval waiver through June 30.
TRICARE-authorized specialty care providers don’t need to wait for TriWest Healthcare Alliance to approve referrals issued by your primary care manager before providing outpatient care.
“After assessing the current state of referrals, DHA has decided to extend the referral approval waiver for many beneficiaries,” said Richard Hart, Division Chief, Health Plan Design, TRICARE Health Plan, at the Defense Health Agency. “This waiver extension will ensure that West Region beneficiaries can continue getting specialty care without interruption to their care.”
However, certain military hospitals and clinics have returned to normal referral processing. This phased approach is enabling TriWest to improve its referral processing system. If your PCM is located at one these facilities, TriWest will process your referral. Keep reading to learn more.
How does the waiver work?
Through June 30, keep following the rules of your TRICARE Prime plan. These rules are described in the TRICARE Choices in the United States Handbook.
Continue seeing your PCM to get referrals for specialty care, even if your PCM isn’t currently in TriWest’s network. (Note: The point-of-service fee waiver is also extended through Sept. 30. These fees are waived for existing referrals with non-network providers in the West Region.)
During the waiver period, you don’t need to wait for TriWest to approve your referral (unless your PCM is at certain military hospitals or clinics). However, the specialist you see must be TRICARE-authorized.
Here are a few key things to remember:
- Ask your PCM for a copy of your referral. Is your PCM at a military hospital or clinic? They may send it:
- Through the MHS GENESIS Patient Portal within 3-5 days
- In the mail within 3-5 days
- To a referral customer service office. You can pick up your copy after your appointment.
- When you see your specialist, bring the copy of your referral, dated Jan. 1 through June 30. You can also bring a copy of the TRICARE West Region Referral Approval Waiver Letter. This is available on www.tricare.mil/west.
- Not sure how to find a specialist? You can:
- Ask your PCM to recommend a local TRICARE-authorized specialist.
- See a specialist you’ve seen before, if they’re TRICARE-authorized.
- Search TriWest’s provider directory to find specialists in your area.
Are there exceptions to the waiver?
This waiver never applies to:
- Inpatient care
- Applied behavior analysis or Autism Care Demonstration services
- Laboratory developed tests
- Extended Care Health Option services
Certain military hospitals and clinics in the West Region have returned to normal referral processing. If your PCM is located at one of these facilities, they’ll let you know. They’ll send your referral to TriWest for processing.
If this applies to you:
- Access your approved referral through TriWest’s secure portal. You can also wait to get it in the mail.
- Your TriWest portal will have instructions on how to schedule an appointment with the assigned specialist. If there’s a problem or you have questions, call TriWest at 888-TRIWEST (874-9378).
What if I have more questions?
Want to learn more about other parts of the West Region transition? Visit TRICARE West Region Transition.
Do you have questions or concerns? You can call TriWest at 888-TRIWEST (874-9378). Or you can contact the Beneficiary Counseling and Assistance Coordinator at your military hospital or clinic.
Courtesy Story
Defense Health Agency