The implementation of Section 714 of the FY25 National Defense Authorization Act (NDAA) marks a significant advancement in military healthcare. This provision allows military members and their families to retain their TRICARE medical providers for telehealth and teletherapy services, regardless of their station or deployment location. By ensuring continuity of care during duty station changes, it expands access to critical mental health services and addresses disparities within the military community.
 
A Framework for Implementation
Under Section 714, the Department of Defense is required to develop and release interim final regulations within 180 days of the President’s signature. Stakeholders, including providers and beneficiaries, are encouraged to participate in discussions to ensure the regulations align with the needs of the military community.
Collaboration is already underway, with TriWest Healthcare Alliance and Humana working closely to provide implementation details for the Department of Defense’s consideration. This proactive approach highlights the importance of engagement during this transition.
 
Key Highlights of Section 714
Expansion of Licensure Portability

• Amends Section 1094(d) of Title 10, U.S. Code, to include mental health providers in TRICARE networks under expanded licensure portability provisions.
• Allows licensed mental health providers to deliver services across state lines to TRICARE beneficiaries, improving access to care.

 
Telehealth Health Services

• Recognizes telehealth as a critical tool for improving mental health care accessibility.
• Ensures mental health providers offering telehealth services to Armed Forces members and their dependents are included under this amendment.

 
Provider Conditions
To deliver services under this provision, providers must:

1. Hold a current license to practice as a mental health professional.
2. Be part of the TRICARE network.
3. Abide by terms and conditions established by the Secretary of Defense to ensure quality care.

 
Advocacy and Collaboration
A hallmark of this transition is TriWest Healthcare Alliance’s commitment to engaging meaningfully with providers, beneficiaries and Humana Military. During recent discussions, TriWest leadership demonstrated responsiveness to feedback and recognition of the challenges faced by clinicians and military families.
 
Providers are encouraged to support the process by joining the TRICARE network, staying informed about policy developments, and contributing feedback during the political proceedings if/when made available to them. 
 
Beneficiaries play a critical role by advocating for their needs and sharing accurate information within their communities.
 
Implications for Military Families
Section 714 directly benefits military members and their dependents by:

• Improving Access: Expanding the reach of licensed mental health professionals through licensure portability and telehealth.
• Enhancing Continuity: Ensuring care is not disrupted by relocations or deployments.
• Maintaining Quality: Leveraging regulatory oversight to uphold care standards.

By addressing these challenges, Section 714 strengthens the support system for those who serve.
 
Moving Forward Together
The transition to TriWest Healthcare Alliance and the implementation of Section 714 represent critical milestones in military healthcare. With interim regulations required within 180 days of the Act’s enactment, providers, beneficiaries, and policymakers must work collaboratively to ensure smooth implementation and address the unique needs of the military community.
 
Let’s approach this transition with collaboration, patience, and a shared commitment to improving military healthcare for all stakeholders. Together, we can build a stronger, more accessible system that supports service members, veterans, their families, and the providers who care for them.

Resources

• Joint Explanatory Statement to Accompany the Service Member Quality of Life Improvement and National Defense Authorization Act for Fiscal Year 2025
• H.R.5009
• 10 USC 1094: Licensure requirement for health-care professionals​

​Author: Dr. Courtney Barber, PsyD, LMFT, AAMFT-S       
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*Note: This document reflects information as of January 25, 2025 and will be updated as new developments occur. *

The military healthcare landscape is undergoing a significant transformation with the transition of TRICARE West services from Health Net Federal Services (HNFS) to TriWest Healthcare Alliance. This shift impacts clinicians serving military members, veterans, and their families across 26 states, presenting both challenges and opportunities. As a clinician, military spouse, and advocate, I am committed to providing accurate information to help our community navigate this transition effectively and confidently.

On Thursday, December 26, 2024, I had the opportunity to meet with Mr. David McIntyre, CEO of TriWest, and Ms. Donna Hoffmeier, Senior Vice President of Strategic Communications & Advocacy. Our discussion centered on the recent transition of TRICARE West Region services from HNFS to TriWest Healthcare Alliance. This significant change presents both challenges and opportunities for providers and beneficiaries alike. Transitions of this scale are undoubtedly complex, but TriWest’s leadership emphasized their commitment to minimizing challenges and ensuring uninterrupted care.

While my ongoing interactions with TriWest leadership suggest they are working diligently to uphold their positive intentions, significant concerns persist among providers as the process unfolds. Many express worries about the potential impact of operating without contracts, delays in payment, and a lack of communication, which has led some to consider discontinuing their work with TRICARE. These concerns are amplified by a history of administrative inefficiencies and communication failures within the TRICARE system. The complexity of navigating TRICARE’s website further complicates the experience for both providers and beneficiaries, often leaving critical questions unanswered. Long wait times for customer support, coupled with inconsistent or inaccurate responses, have eroded trust and added frustration. For providers, this has translated to delays in securing essential information, confusion over updated processes, and difficulties maintaining a seamless care experience for their patients. Beneficiaries, in turn, have experienced appointment cancellations, delays in obtaining referrals, and extended wait times to access care. 

Much of this could be mitigated by the Defense Health Agency (DHA) taking greater responsibility for the issues at hand, releasing a clear plan to address the current challenges, ensuring payments are being executed properly in both regions, and keeping contract execution on track to meet the 90-day waiver deadline set by the DHA. These cascading issues highlight the urgent need for clear communication, streamlined systems, and robust support to rebuild confidence and ensure that providers can continue delivering high-quality care.

It is important to clarify that TRICARE is overseen by the Defense Health Agency (DHA), a division of the Department of Defense (DoD). The DHA is responsible for establishing the policies, guidelines, and regulations that govern TRICARE operations, ensuring compliance with federal laws and alignment with military healthcare standards. Contractors, such as TriWest, are tasked with administering TRICARE programs within specific regions. Their responsibilities include managing provider networks, processing claims, and delivering customer support. Although their names are similar, it is important to note that TriWest functions under the oversight of TRICARE and is responsible for implementing its policies and managing the program's operational aspects.

Key Challenges and Provider Concerns
Continuity of Care
Providers are increasingly concerned about operating without contracts, delays in payments, and the potential for disruptions in patient care. These challenges have led to discussions among clinicians about the possibility of discontinuing their work with TRICARE, raising alarms in both the provider and beneficiary communities. This is especially troubling given the widespread acknowledgment of an existing shortage of providers, particularly in specialized areas of care.

A recent survey (December 2024) of mental health providers, primarily in the Colorado area, shared with TriWest leadership, highlighted the following insights:

• 75% of providers surveyed have initiated the credentialing process.
• 17% have completed credentialing with executed contracts.
• 73% are in various stages of the waiting process.

​Among providers who have fully completed credentialing:

• 60% are currently accepting new clients.

Within this group of providers accepting new clients:

• 72% can accommodate up to 10 new clients.
• 11% can accept 10–20 new clients.
• 11% can accept 20–30 new clients.
• 5% can accept more than 30 clients.

These findings underscore the concern that there are currently insufficient in-network providers to meet the needs of beneficiaries.

Communication Issues
A history of administrative system failures and inadequate communication with both providers and beneficiaries has eroded trust. The complexity and layered structure of the TRICARE website often makes it difficult to navigate and locate accurate or relevant information. Both providers and beneficiaries face long wait times when trying to reach support, often receiving little to no helpful information or inconsistent and inaccurate responses. For beneficiaries, these challenges have resulted in uninformed providers, canceled appointments (sometimes after patients have been waiting months to be seen), and confusion about the referrals process. These issues compound frustrations and further erode confidence in the system.
 
Stipulations for TRICARE Prime and Select Beneficiaries
To help clinicians guide their patients during the transition, here are key provisions based on their plan type:  
 
For TRICARE Prime Enrollees
If the provider is a TRICARE network provider: 

• Patients may keep seeing their provider until the referral ends or June 30, 2025, whichever comes first. TRICARE Prime copayments apply.

If the provider is no longer a TRICARE network provider:

• You can keep seeing your provider (TRICARE Prime copayments apply) until April 1, 2025 under TRICARE's waiver. 
  

This waiver does not apply to:

1. Inpatient care
2. Applied behavior analysis or Autism Care Demonstration services
3. Laboratory developed tests
4. Extended Care Health Option services
   

If the patient requires any of the four services above, TriWest will still need to pre-authorize their referral before they see the specialist.

• Starting April 2, 2025, if the provider is still a non-network provider, you'll have to pay point-of-service fees. You may also have to pay up front and file a claim when seeing a nonparticipating, non-network provide.

For Care Not Requiring Pre-Authorization
Patients may keep seeing their provider and pay TRICARE Prime copayments. Starting April 2, 2025, if the provider is still a non-network provider, the patient may have to pay point-of-service fees and file a claim when seeing a nonparticipating, non-network provider.
 
*Point-of-Service (POS) option allows TRICARE Prime beneficiaries to receive nonemergency care from any TRICARE-authorized provider without a referral from their Primary Care Manager (PCM). While this offers greater flexibility in choosing healthcare providers, it comes with higher out-of-pocket costs.
Key aspects of the POS option include:

• Annual Deductible: Before TRICARE shares the cost, you must pay a deductible of.
• Cost-Share: After meeting the deductible, you're responsible for 50% of the TRICARE-allowable charge for the services received. 
• Exclusions: POS costs don't count toward your annual catastrophic cap—the maximum.

Situations where the POS option doesn't apply:

• Active-duty service members cannot use the POS option.
• If you have a referral from your PCM, standard TRICARE Prime costs apply.
• Emergency care and preventive services from network providers don't fall under the POS option.*

​
For TRICARE Select Enrollees
Starting January 1, 2025
If you are a TRICARE network provider:

• You may continue seeing TRICARE Select patients until their pre-authorization expires or June 30, 2025, whichever comes first.

 
If you are no longer a TRICARE network provider:

• Patients may still see you, but they will face higher out-of-pocket costs, including non-network copayments, deductibles, or cost-shares.
• To help minimize their expenses, patients may request a new pre-authorization to transition to a TRICARE network provider.

 
For Care Not Requiring Pre-Authorization:
Beginning January 1, 2025, patients who access care from you as a non-network provider will likely face increased out-of-pocket costs. They may also be required to pay upfront and file their own claims for reimbursement.

Provider Resources and Support  
To assist clinicians during this transition, TriWest offers the following resources:  
 
Joining the Network
  Providers can join the TRICARE network by:  
  1. Completing the "Join Our Network" form 
  2. Submitting required credentialing documents.  
  3. Completing the contracting process.  
 
Claims Submission Options

• Electronic Submission (Payer ID 99726): 
  1. XPressClaim
  2. Availity
  3. TriWest’s secure provider portal.  
• Mail Submission: TRICARE West Claims, P.O. Box 202160, Florence, SC 29502-2160.

 
*Please be advised that the current TriWest states the following about payment turnaround time: "TriWest will make best efforts to process Clean Claims within thirty (30) days of receipt and will make payment directly to Provider for Covered Services rendered by Provider to Beneficiaries in accordance with the terms of the Reimbursement Exhibit." *
 
Portal Services (Availity)

• Client eligibility and benefits
• Online portal for claims management
• Electronic funds transfer enrollment
• Real-time claim status checking
• TRICARE remittance advice

 
Supporting Providers and Holding the DHA Accountable
The transition of TRICARE West services to TriWest represents a pivotal moment in military healthcare, presenting both challenges and opportunities. For providers, this change highlights the importance of proactive engagement and self-advocacy to ensure uninterrupted care for members and beneficiaries. By staying informed about evolving policies, addressing potential issues early, and maintaining open communication, providers can play a vital role in mitigating disruptions and maintaining the high standard of care on which military individuals and families rely.
 
As TRICARE is directly managed by the Defense Health Agency (DHA), the agency must appropriately be held accountable for addressing systemic gaps, improving communication, ensuring that contracted entities have the necessary resources to execute their contracts effectively, and overseeing that these contractors fulfill their obligations successfully. Accountability also includes ensuring timely payments to providers, as delays in payment exacerbate provider frustration and jeopardize the continuity of care. Additionally, the DHA must rebuild trust within both the provider and beneficiary communities by providing transparent, consistent, and timely updates to reduce confusion, prevent delays, and support stakeholders in navigating the system effectively. Failure to fulfill these responsibilities risks worsening access to care for beneficiaries as frustrated providers may choose to disengage from the system altogether.
 
The success of this transition depends on a collective effort to hold the DHA accountable for resolving systemic issues within TRICARE, demand improved communication, and advocate for political support to ensure meaningful reforms. By stepping into this role, providers can drive the development of a stronger, more responsive healthcare system that benefits all stakeholders.
  
Web Resources

• TriWest “Join Our Network” form
• TriWest Provider Directory
• TRICARE West “What About Care After Jan. 1, 2025?” 
• Learn How Referrals and Specialty Care Will Work as New TRICARE Contracts Start in 2025
• TRICARE West Region

​Author: Dr. Courtney Barber, PsyD, LMFT, AAMFT-S       
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*Note: This document reflects information as of January 25, 2025 and will be updated as new developments occur. *

On Thursday, December 26, 2024, I had the opportunity to meet with Mr. David McIntyre, CEO of TriWest, and Ms. Donna Hoffmeier, Senior Vice President of Strategic Communications & Advocacy. The focus of our discussion was the recent transition of TRICARE West Region services from Health Net Federal Services (HNFS) to TriWest, a move that represents both challenges and opportunities. One of the primary topics we discussed was the potential for disruptions in care continuity. Transitions of this scale are undoubtedly complex, but TriWest’s leadership emphasized their commitment to minimizing challenges and ensuring continuity of care.

While my continued interactions with TriWest leadership indicate that they are striving to maintain their positive intentions, significant concerns remain among providers as this process unfolds. These concerns stem from fears of operating without contracts and increasing discussions among providers about discontinuing their work with TRICARE. These challenges are deeply rooted in a history of administrative system failures and a significant lack of trust, further exacerbated by TRICARE’s inadequate communication with both its providers and beneficiaries. The complexity and layered structure of the TRICARE website often makes it difficult to navigate and locate accurate or relevant information. Additionally, both providers and beneficiaries face impossibly long wait times when attempting to reach support, often receiving little to no helpful information or inconsistent and inaccurate responses. For beneficiaries, these challenges have resulted in providers being uninformed, leading to the cancellation of appointments (sometimes after waiting months to be seen), confusion about the current referrals process, and long phone wait times that frequently yield little to no answers. These ongoing issues have compounded frustrations and further eroded confidence in the system.
 
It is important for members and beneficiaries to understand that TRICARE is managed by the Defense Health Agency (DHA). As part of the Department of Defense (DoD), the DHA oversees the administration of healthcare services through TRICARE, ensuring its implementation and delivery meet the needs of beneficiaries. This includes establishing policies, guidelines, and regulations that govern TRICARE operations, as well as ensuring compliance with federal laws and military healthcare standards. The DHA also awards and manages contracts with private health organizations, such as TriWest and Humana Military, which administer the TRICARE program in specific regions. These contractors are responsible for managing provider networks, processing claims, and delivering customer support. While the similarly structured names of TriWest and TRICARE often create confusion, TRICARE oversees TriWest and its operations.

What does this mean for you? Here is what we know: 
For TRICARE Prime Enrollees
If the provider is a TRICARE network provider: 

• Patients may keep seeing their provider until the referral ends or June 30, 2025, whichever comes first. TRICARE Prime copayments apply.

If provider is no longer a TRICARE network provider:

• You can keep seeing your provider (TRICARE Prime copayments apply) until April 1, 2025 under TRICARE's waiver. 

This waiver does not apply to:

1. Inpatient care
2. Applied behavior analysis or Autism Care Demonstration services
3. Laboratory developed tests
4. Extended Care Health Option services

If you need any of these four services above, TriWest will still need to pre-authorize your referral before you see your specialist.

• Starting April 2, 2025, if the provider is still a non-network provider, you'll have to pay point-of-service fees. You may also have to pay up front and file a claim when seeing a nonparticipating, non-network provide.

For Care Not Requiring Pre-Authorization
Patients may keep seeing their provider and pay TRICARE Prime copayments. Starting April 2, 2025, if the provider is still a non-network provider, the patient may have to pay point-of-service fees and file a claim when seeing a nonparticipating, non-network provider.
​
For TRICARE Select Enrollees
Starting January 1, 2025
If your provider is a TRICARE network provider:

• You can keep seeing your provider until the preauthorization ends or June 30, 2025, whichever comes first.

If your provider is no longer a TRICARE network provider:

• You can keep seeing your provider but you’ll pay a non-network copayment/deductible/cost-share. To avoid higher costs, ask for a new pre-authorization to a TRICARE network provider.

 
For Care Not Requiring Pre-Authorization
Starting Jan. 1, 2025, make sure to see a TRICARE network provider. If you don’t, you’ll pay more out-of-pocket. You may also have to pay up front and file a claim when seeing a nonparticipating, non-network provider.

*Understanding the Point-of-Service (POS) option: 
POS allows TRICARE Prime beneficiaries to receive nonemergency care from any TRICARE-authorized provider without a referral from their Primary Care Manager (PCM). While this offers greater flexibility in choosing healthcare providers, it comes with higher out-of-pocket costs.
Key aspects of the POS option include:

• Annual Deductible: Before TRICARE shares the cost, you must pay a deductible of.
• Cost-Share: After meeting the deductible, you're responsible for 50% of the TRICARE-allowable charge for the services received. 
• Exclusions: POS costs don't count toward your annual catastrophic cap—the maximum.

Situations where the POS option doesn't apply:

• Active-duty service members cannot use the POS option.
• If you have a referral from your PCM, standard TRICARE Prime costs apply.
• Emergency care and preventive services from network providers don't fall under the POS option.*

For TRICARE Select Enrollees
If Your Pre-Authorization Extends Past January 1, 2025:
If your provider remains in the TRICARE network, you can continue care until the pre-authorization expires or June 30, 2025, whichever comes first.  
 
If your provider is no longer in the network:  

• You may still see them, but out-of-pocket costs will increase.
• You’ll need to pay a non-network copayment or cost-share, which is higher than in-network costs.  

 
For Care That Does Not Require Pre-Authorization:

• Starting January 1, 2025, using TRICARE network providers will help you avoid higher out-of-pocket costs.  
• If you see a nonparticipating/non-network provider, you may have to pay upfront and submit your own claims.  

 
What You Can Do Next:

1. Check your provider’s network status. Contact your provider or use the TriWest Provider Directory.   

1. Take the TRICARE West Region Referral Approval Waiver Letter with you to your next appointment or provide it to your provider before your next visit.
2. Request a new referral or pre-authorization if needed: This ensures continuity of care and minimizes your costs. 
3. Consider switching to a TRICARE network provider. If your provider is no longer in the network, this can help you avoid higher fees. 
4. If your provider is not in the network but has stated they have started the process, continue to check for updates on their status on the TriWest Provider Directory.   
5. Set up your TriWest beneficiary portal. 
6. Keep yourself accurately informed. 
7. Please plan ahead to ensure uninterrupted care and avoid unexpected costs. 

The transition of TRICARE West services to TriWest represents a critical juncture for members and beneficiaries. While the process brings challenges, it underscores the importance of proactive planning and self-advocacy by both groups, particularly in their interactions with the DHA (TRICARE). By remaining informed about benefits and coverage, advocating for their needs, and addressing potential issues early, members and beneficiaries can mitigate disruptions and maintain access to essential healthcare services. This transition also continuously offers the DHA an opportunity to identify gaps, refine strategies, and rebuild trust with members and beneficiaries alike should they choose to make this a priority.    
 
Web Resources​

• TriWest Provider Directory
• TRICARE West “What About Care After Jan. 1, 2025?” 
• Learn How Referrals and Specialty Care Will Work as New TRICARE Contracts Start in 2025
• TRICARE West Region

Author: Dr. Courtney Barber, PsyD, LMFT, AAMFT-S       
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*Note: This document reflects information as of January 25, 2025 and will be updated as new developments occur. *