TRICARE billing for East and West regions
Billing for TRICARE beneficiaries, including network and non-network providers, regional contractor rules, referrals and TRICARE For Life.
Working with TRICARE
TRICARE covers active duty service members, retirees and their families. Since January 1, 2025, the East Region is administered by Humana Military and the West Region by TriWest Healthcare Alliance. TRICARE For Life works as secondary coverage after Medicare.
Plan types we bill:
- TRICARE Prime
- TRICARE Select
- TRICARE For Life
- TRICARE Reserve Select
Credentialing and enrollment
Providers must be TRICARE-authorized to be paid. Network providers contract with the regional contractor, while non-network providers can still see TRICARE patients and choose whether to accept assignment on each claim.
Prepare
Licenses, NPI, CAQH and group details checked and updated.
Apply
Application submitted for each provider and location.
Follow up
Status checked every 1 to 2 weeks until approval.
Confirm
Effective date and participation confirmed before billing.
Claims, eligibility and portals
Claims go to the regional contractor for the patient’s region, and TRICARE For Life claims are processed after Medicare. Prime members usually need referrals for specialty care.
Denials we prevent with TRICARE
- Claim sent to the wrong region
- Missing referral or authorization for Prime members
- Provider not TRICARE-authorized
- Medicare not billed first for TRICARE For Life
- Patient cost-share limits not followed by non-network providers
Questions about TRICARE
Can we see TRICARE patients without joining the network?
Yes, if you are TRICARE-authorized. Network status affects payment, referrals and patient cost-sharing.
Other payers and related services
Trademarks belong to their owners. MedAi Billing Solutions is an independent billing company, not affiliated with any payer or government agency.
Get help with TRICARE claims
Send a few details and we will set up a short call to review your claims, denials and A/R. No cost and no commitment.
We sign a Business Associate Agreement before we handle any patient data.