TriWest Healthcare Alliance: TRICARE West Contractor Guide

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TriWest Healthcare Alliance is the Department of Defense (DoD) contractor responsible for managing the TRICARE West Region. Under the current T5 (fifth generation) contract, TriWest assumed operations on January 1, 2025, serving approximately 2.8 million beneficiaries across 26 states.

## Who they are TriWest Healthcare Alliance is a privately held corporation based in Phoenix, Arizona, specifically formed to serve the military and veteran community. On January 1, 2025, they replaced Health Net Federal Services (HNFS) as the sole administrator for the TRICARE West Region under the T5 contract, which has an estimated total value of $58 billion over nine years.

## What they do TriWest acts as the administrative bridge between the Department of Defense and civilian healthcare providers. Their core responsibilities include: * **Provider Network Management:** Recruiting and maintaining a network of civilian doctors, specialists, and hospitals that accept TRICARE. * **Claims Processing:** Paying healthcare providers for covered services rendered to West Region beneficiaries. * **Medical Necessity Reviews:** Managing the prior authorization and referral process for specialized care. * **Customer Service:** Operating call centers to assist with enrollment, billing questions, and benefit education. * **Population Health:** Providing case management, disease management, and wellness programs. * **Enrollment Services:** Processing TRICARE Prime and Select enrollments and changes.

## How to reach them * **Member Portal:** [triwest.com/tricare-west](https://www.triwest.com) * **Customer Service:** 1-844-866-WEST (1-844-866-9378) * **Mobile App:** TriWest Mobile (Available on iOS and Android) * **Mailing Address for Claims:** TriWest Healthcare Alliance P.O. Box 7068 Camden, SC 29021-7068

## Service area TriWest manages the **West Region**, which includes the following 26 states: Alaska, Arizona, Arkansas, California, Colorado, Hawaii, Idaho, Illinois (select counties), Iowa, Kansas, Louisiana, Minnesota, Missouri, Montana, Nebraska, Nevada, New Mexico, North Dakota, Oklahoma, Oregon, South Dakota, Texas (excluding the Areas Around El Paso), Utah, Washington, Wisconsin, and Wyoming.

*Note: Since Jan 1, 2025, under T5, several states transitioned from the East Region to the West Region (Arkansas, Illinois, Louisiana, Oklahoma, and parts of Texas).*

## Common issues & how to escalate * **Referral Delays:** If a specialty care referral is not processed within the standard 3-5 business days, members should first check the "Secure Correspondence" section of the TriWest portal. * **Network Gap Disputes:** If TriWest claims there is a network provider available but the provider is not accepting new patients, you may request a "Point of Service" waiver through their network management department. * **Claims Denials:** For 2026 claims denied in error, beneficiaries must file a formal appeal in writing within 90 days of the Explanation of Benefits (EOB) date. * **How to Escalate:** If a standard customer service agent cannot resolve a billing or access-to-care issue, ask to speak with a **Lead** or a **Beneficiary Counseling and Assistance Coordinator (BCAC)** at the nearest Military Treatment Facility (MTF). You can also contact the Defense Health Agency (DHA) via the TRICARE.mil feedback form if the contractor fails to meet contract performance standards.

## Sources * **TRICARE.mil Official West Region Page:** https://tricare.mil/west * **TriWest Official Site:** https://www.triwest.com * **Defense Health Agency T5 Contract Announcement:** https://health.mil/News/Articles/2022/12/22/T5-TRICARE-Contract-Awards