TRICARE's Regional Consolidation

To better serve beneficiaries worldwide, the Department of Defense (DoD) is consolidating the TRICARE regions in the continental United States this year from 12 regions to three—West, North and South.

The new regional contractors are TriWest Healthcare Alliance (West), Health Net Federal Services, Inc. (North) and Humana Military Healthcare Services, Inc. (South)

This move is intended to simplify the administration of the TRICARE program and improve beneficiaries’ access to health care. It is also intended to make TRICARE more accountable to beneficiaries and providers alike, in particular by streamlining the various processes and steps that providers take to serve beneficiaries in a simpler and more efficient manner.

In addition to consolidating regions, the DoD “carved out” various other contracts (e.g., retail pharmacy, TRICARE For Life) for services that were previously administered separately by the regional health care contractors. Now these services are centralized under national contracts.

Known as “the next generation of contracts,” regional consolidation and carve-out programs are designed to improve health care portability for beneficiaries and simplify administrative processes for TRICARE and providers.

West Region Rollout Schedule

Each of the new TRICARE regions will be phased in according to a rollout schedule (see chart). In the west, former regions 7, 8, 9, 10, 11, Alaska and Hawaii will become the TRICARE West Region and will begin working with TriWest.

Practices in the following states and locations will be part of the West Region: Alaska, Arizona, California, Colorado, Hawaii, Idaho, Iowa (except for the Rock Island Arsenal area), Kansas, Minnesota, Missouri (except for the St. Louis area), Montana, Nebraska, Nevada, New Mexico, North Dakota, Oregon, South Dakota, Utah, Washington,Wyoming and the southwestern corner of Texas.

What’s New?

As a West Region provider, you will continue to deliver the same quality care you always have. There are minimal changes to the delivery of the TRICARE benefit.

Most of what’s new is administrative as you begin working with TriWest. Once you are part of the West Region, for example, you will begin submitting claims to TriWest’s new claims processor, Wisconsin Physicians Service (WPS).

(See “TriWest Contracts with WPS for Claims Processing” in this issue for details.) You also will need to begin calling TriWest at 1-888-TRIWEST (1-888-874-9378) and using TriWest’s paperwork for referral and authorization requests.

You can expect these changes to be smooth, particularly if your practice utilizes the many resources TriWest has developed to ensure a seamless transition for providers (see “Introducing TriWest Healthcare Alliance” in this issue ).