TRICARE June 2026 Provider Pulse

Understanding TRICARE Plan Options: What Providers Need to Know

You care for service members, retirees, and their families every day. To support them effectively, it’s important to understand the TRICARE health plans they rely on. Knowing how these plans work helps you provide timely care, file accurate claims, and avoid preventable billing issues.

Confirm TRICARE Coverage Up Front

Confirm your beneficiary’s TRICARE plan before determining coverage or starting treatment. A Uniformed Services ID card does not show plan type, so verify eligibility through the provider portal, Availity. This ensures you know whether the patient is enrolled in TRICARE Prime, TRICARE Select, or a specialty plan, and what referral, authorization, or cost‑sharing requirements apply.

How to Verify Coverage

• Log in to the provider portal, Availity.
• From the top navigation menu, select Patient Registration.
• Open the Eligibility and Benefits Inquiry application.
• Select the TRIWEST - TRICARE payer.
• Enter the required patient information.
• For TRICARE inquiries, the Member ID must be one of the following without dashes or spaces:
  • the patient’s nine-digit Social Security Number (SSN)
  • the patient’s 11-digit DEERS Beneficiary Number (DBN)
• Submit the inquiry to view the patient’s eligibility and benefit details.

The overview below highlights key information to help guide your daily interactions with TRICARE patients.

TRICARE Prime

TRICARE Prime is a managed care option with a primary care manager (PCM) who coordinates routine and specialty care. Plan options include TRICARE Prime, TRICARE Prime Remote, US Family Health Plan, TRICARE Prime Overseas, and TRICARE Prime Remote Overseas.

Key points:

• TRICARE Prime beneficiaries need a PCM referral for certain specialty care.
• Active duty service members require referrals for all nonemergency specialty services.
• Patients generally see network providers and most pay copayments for services.
• Unauthorized specialty care may lead to denied claims or higher patient costs.
• Network providers submit claims on the patient’s behalf.

TRICARE Select

TRICARE Select is a preferred provider option that allows enrollees to see any TRICARE authorized provider without a referral. Some services still require pre authorization. Plan options include TRICARE Select and TRICARE Select Overseas.

Key features:

• No referrals are required for specialty care, but some services still require pre-authorization.
• Patients may see network or non network providers; non network care may increase costs.
• Deductibles and copayments are generally higher than TRICARE Prime.
• Copayments may be due at the time of service.
• Network providers file claims; patients may need to file their own when seeing non-network providers.

Specialty TRICARE Plans

These plans support specific groups based on Medicare eligibility, age, or Reserve component service. Plans include TRICARE For Life, TRICARE Reserve Select, TRICARE Retired Reserve, and TRICARE Young Adult.

Key features:

• Eligibility and coverage requirements vary; verify network status at each visit.
• TRICARE For Life requires Medicare Part A and Part B; Medicare pays first, TRICARE pays second.
• TRICARE Reserve Select and Retired Reserve are premium based; lapses in payment may affect coverage.
• TRICARE Young Adult follows TRICARE Prime or TRICARE Select rules, depending on the chosen level.
• Coverage rules may differ overseas; confirm authorization and claims processes.

For detailed plan information, visit TRICARE Health Plans web page.

2026 TRICARE ACD Annual Training Update Available

The 2026 update to the Autism Care Demonstration (ACD) annual training is live on the provider portal, Availity! ABA providers must complete the ACD Annual Training Module annually to remain compliant with Chapter 18, Section 3 of the TRICARE Operations Manual requirements. Failure to complete the required training may result in a 10% penalty against all claims until training is complete.

This on-demand, web-based module can be accessed at any time:

• Log in to the provider portal, Availity.
• Go to the TRIWEST - TRICARE Payer Space.
• Click on the Access TriWest Leaning Center tile.
• Search “Annual Provider Training.”
• You can either enroll for a later training date or begin the training by clicking “Start Now.”

Don’t have a provider portal, Availity, account? Don’t worry. It is easy to sign up.

• Visit the provider portal, Availity.
• Click “Get Started” in the top right corner to begin the process.

Supporting Maternal Mental Health: Training Opportunity for TRICARE Providers

Maternal mental health is a critical component of overall family well-being. Conditions such as perinatal depression, anxiety, and other mood disorders affect many individuals during pregnancy and the postpartum period.

To support TRICARE providers in delivering high-quality maternal mental health care, TriWest has partnered with Postpartum Support International to offer a comprehensive 6-hour virtual CME training focused on maternal mental health. This evidence-based training equips clinicians with practical tools to recognize, assess, and address perinatal mental health concerns.

Training Details:

• Format: Virtual
• Cost: $250
• Special offer: The first 130 participants will receive a $200 coupon. Use code TriWest-HA25-OD-Mil

Interested? Get more info about the training.

TRICARE Provider Handbook Updates

There are no updates to the TRICARE Provider Handbook this month.