Since the TriWest Healthcare Alliance became the contractor for the TRICARE West Region on January 1, 2025 and six states were added to the West Region from the East, providers from both the East and West Regions have experienced severe operational challenges including non-payment. APTA is working closely with congressional partners to help rectify the situation.
APTA has been working to help address TRICARE providers not being properly reimbursed for the vital services they provide for service members and their families. We are pleased to announce that congressional partners have formally reached out to the Defense Health Agency in Congress’s oversight capacity, demanding to know how this problem occurred, how it will be fixed, and how the agency will ensure it does not happen again. We are actively monitoring this issue and will continue to address it and update APTA members going forward.
If you are a TRICARE provider affected by issues such as non-payment for medically necessary care or coverage gaps for U.S. service members and their families, please click the button above and reach out to your members of Congress. Share your experience and urge them to contact the Defense Health Agency to end the disruption and resolve the operational breakdown.
As a reminder, the DHA waived the requirement to obtain approval for referrals to outpatient specialty care for TRICARE Prime enrollees from January 1 – March 31, 2025. Providers do not need to submit referral or authorization requests for TRICARE Prime enrollees for outpatient care during the temporary waiver period and referrals issued are valid for services rendered through June 30, 2025.
“APTA recognizes the serious challenges TRICARE providers are facing and is actively working with congressional partners to push for a resolution. We remain committed to assisting our impacted members and ensuring these issues are swiftly addressed.” – APTA President Kyle Covington, PT, DPT, PhD
