HealthNet to TriWest: Navigating the 2025 TriCare West Changes
The 2025 changes of TriCare West are here, and they’re bringing a major shift for providers, billing specialists, and patients. As of January 1, 2025, TriCare West’s contract with HealthNet Federal Services has ended, and TriWest Healthcare Alliance is now managing claims, referrals, and authorizations. In this guide, I’ll walk you through everything you need to know about these changes—and how to prepare.
Key Takeaways
- As of January 1, 2025, TriCare West’s contract with HealthNet Federal Services ended; TriWest Healthcare Alliance is the new contractor.
- Providers need to update credentialing, EFT payments, and clearinghouse enrollments immediately.
- Key deadlines: Submit 2024 claims to HealthNet by April 1, 2025, and transition referrals before June 30, 2025.
- Patients must switch to TriWest’s portal and check referral expiration dates.
- Six states are transitioning from TriCare East to West, impacting providers in those regions.
What Changed with TriCare West in 2025?
If you’ve been working with TriCare West under HealthNet Federal Services, this is going to be a big shift. Effective January 1, 2025, TriCare West transitioned to a new contractor: TriWest Healthcare Alliance. This means HealthNet Federal Services is no longer managing claims, authorizations, or referrals.
To summarize the key change:
- TriCare West’s third-party administrator is now TriWest Healthcare Alliance.
If you’re wondering what this means for you—whether you’re a provider, billing office, or even a patient—keep reading, because the details are crucial.
How Does This Impact Providers?
For practices currently contracted with TriCare West, the transition brings some extra work. You’ll need to ensure that your credentials, claims submissions, and patient records are switched over to TriWest Healthcare Alliance. If you skip this, you risk delays in getting paid for your services—or worse, losing revenue altogether.
Credentialing & Contracting: What You Need to Do
If you were in the middle of credentialing or contracting with HealthNet Federal Services, here’s the deal:
- Check your application status.
- Call HealthNet Federal Services to confirm whether your application was processed.
- If it wasn’t approved before January 1, 2025, you’ll need to start over with TriWest.
- Yes, it’s frustrating, but unfortunately, it’s necessary.
- Resubmit to TriWest.
- Initiate credentialing and contracting with TriWest as soon as possible. The grace period for this transition ends April 1, 2025—so don’t wait!
- Make Sure Your Group & Providers Are Credentialed.
- Confirm that your entire group and individual providers are enrolled with TriWest. Without this, you won’t be able to see TriCare West patients or bill for services.
What Is the Difference Between Credentialing and Contracting?
Claims Submission & Deadlines
Here’s the big one for billing teams: 2024 claims have a strict submission deadline.
- All claims with dates of service in 2024 must be submitted to HealthNet Federal Services by April 1, 2025.
- Claims for services rendered January 1, 2025, and beyond must go to TriWest Healthcare Alliance.
If you miss these deadlines, you won’t get paid. And no one wants that!
What About Authorizations & Referrals?
One of the most common questions about the 2025 changes of TriCare West is: What happens to existing referrals and authorizations?
Here’s How It Works:
- Existing referrals/authorizations issued by HealthNet Federal Services will carry over to TriWest.
- However, there’s a catch:
- TriWest will honor these only until the expiration date or June 30, 2025, whichever comes first.
- If your referral expires after June 2025, you’ll need to request a new referral/authorization through TriWest.
Pending Referrals/Authorizations
- Any referrals or authorizations that were submitted to HealthNet but not processed will be forwarded to TriWest for completion.
- Follow up with TriWest to ensure they’ve received them. If they haven’t, go back to HealthNet to confirm the referral was forwarded.
Portal Access: HealthNet vs. TriWest
If you’ve been using HealthNet’s portal, here’s a heads-up:
- The HealthNet portal will remain accessible until June 30, 2025.
- After that, all information will need to be accessed through the TriWest portal.
Make sure you:
- Set up access to the TriWest portal ASAP.
- Start transitioning your workflow now to avoid interruptions.
Key Dates to Remember
Here’s a quick timeline to keep track of the 2025 changes of TriCare West:
| Key Event | Deadline |
|---|---|
| HealthNet contract ends | January 1, 2025 |
| All claims for 2024 due to HealthNet | April 1, 2025 |
| Referrals/authorizations honored | Until June 30, 2025 or expiration |
| HealthNet portal access ends | June 30, 2025 |
How to Handle Clearinghouses, Payments & the Jurisdiction Shift
Now that you’ve got a solid understanding of the 2025 changes of TriCare West, let’s dive deeper into the nitty-gritty details. In this part, we’re covering everything you need to know about clearinghouse enrollments, electronic payments, and the six-state jurisdiction shift that’s shaking things up for providers in Arkansas, Illinois, Louisiana, Oklahoma, Texas, and Wisconsin. Buckle up, because this is where the logistics get real.
Clearinghouse Enrollments: What You Need to Know
If your office uses a clearinghouse to handle TriCare West claims, this transition means you’ll need to confirm whether your clearinghouse is ready to work with TriWest Healthcare Alliance. Trust me—you don’t want to assume this will happen automatically. Clearinghouses require additional enrollment steps for claims submissions, Electronic Remittance Advice (ERAs), and Electronic Funds Transfers (EFTs) when a payer changes.
Step 1: Confirm Clearinghouse Enrollment for TriWest
Reach out to your clearinghouse and ask these questions:
- Do we need to enroll separately for submitting TriWest claims?
- Are there any special forms or setup requirements for TriWest?
- Is enrollment required to receive ERAs from TriWest?
Most clearinghouses will make the process fairly seamless, but you need to initiate this ASAP to avoid claim denials or delays.
Switching Your EFT Payments: Don’t Lose Revenue
One of the most overlooked steps during contractor transitions is updating your Electronic Funds Transfer (EFT) payment information. EFTs allow payments to go directly into your bank account, but here’s the kicker: HealthNet and TriWest don’t share this data.
What this means for you:
- You’ll need to re-enroll your EFT information with TriWest Healthcare Alliance to continue receiving payments electronically.
How to Update EFTs for TriWest
- Reach Out to TriWest:
- TriWest should have an EFT enrollment process available on their provider portal.
- You’ll likely need your practice’s banking information and tax identification number (TIN).
- Check for Payment Overlap:
- Claims submitted to HealthNet for 2024 dates of service will still pay out through HealthNet’s EFT system until April 1, 2025.
- Claims for 2025 dates of service onward will pay out through TriWest, but only if your EFT setup is complete.
- Reconcile Payments:
- Keep an eye on your deposits to ensure funds are coming from the right payer. You’ll be juggling payments from both HealthNet and TriWest for a few months during the transition period.
Jurisdiction Shift: The Six States Moving to TriCare West
Here’s a curveball for providers: As of January 1, 2025, six states previously under TriCare East have been reassigned to TriCare West. This means claims for patients in these states must now be submitted to TriWest Healthcare Alliance, not Humana (TriCare East’s contractor).
Which States Are Affected?
- Arkansas
- Illinois
- Louisiana
- Oklahoma
- Texas
- Wisconsin
If your practice sees patients in any of these states—or neighboring states where patients may reside—you’ll need to adjust your processes immediately.
Texas Providers: A Special Note
For Texas, things have always been a bit… complicated. Historically, whether you sent claims to TriCare East or TriCare West depended on the patient’s specific city of residence. This jurisdictional ambiguity might be going away, as it appears that all Texas patients are now moving to TriCare West under TriWest Healthcare Alliance.
If you frequently bill TriCare for Texas patients, here’s what to do:
- Verify the patient’s jurisdiction: Check with TriWest or Humana to ensure you’re sending claims to the right place.
- Keep an eye on updated maps and guidance from TriWest for clarification.
How This Affects Patients
It’s not just providers who need to adjust—patients will also feel the impact of the 2025 changes of TriCare West. Many patients rely on their portals for referrals, authorizations, and claim updates, and the transition from HealthNet to TriWest may cause confusion.
Patient Portal Access
- HealthNet’s patient portal will remain active until June 30, 2025, but patients should start transitioning to TriWest’s portal sooner rather than later.
- Encourage your patients to create accounts on TriWest’s platform and update their insurance info with your office.
Referral/Authorization Transitions
Patients will need to be aware of the June 30, 2025, cut-off for their existing HealthNet referrals and authorizations. This means:
- If they require ongoing care past this date, they’ll need to request a new referral/authorization from TriWest.
- Help your patients stay on top of these deadlines to avoid disruptions in care.
Final Recap of Key Action Items
Here’s a quick rundown of what you need to do right now:
| Task | Deadline |
|---|---|
| Enroll with TriWest for claims/ERAs | ASAP |
| Update EFT payments to TriWest | ASAP |
| Submit 2024 claims to HealthNet | April 1, 2025 |
| Transition to TriWest portal access | June 30, 2025 |
| Apply for new referrals/authorizations | After June 30, 2025 (if needed) |
FAQ: 2025 Changes of TriCare West
If you’re still scratching your head about the 2025 changes of TriCare West, don’t worry—we’ve got you covered! Below are the most common questions (and their answers) to help you navigate this big transition from HealthNet Federal Services to TriWest Healthcare Alliance. Whether you’re a provider, billing specialist, or patient, this FAQ will break it all down for you.
What happened to HealthNet Federal Services?
As of January 1, 2025, TriCare West’s contract with HealthNet Federal Services ended. All TriCare West claims, referrals, and authorizations are now managed by TriWest Healthcare Alliance.
Why did TriCare West switch contractors?
The government periodically reviews and reassigns contracts for military insurance programs like TriCare. This change is part of that process. HealthNet is out, and TriWest won the contract to take over TriCare West operations.
What states are affected by this change?
This change affects all TriCare West states, but six states are also moving from TriCare East to TriCare West:
- Arkansas
- Illinois
- Louisiana
- Oklahoma
- Texas
- Wisconsin
If you’re in or near these states, check your patients’ insurance details to confirm where claims need to go.
What’s the timeline for the transition?
Here are the key dates you need to know:
- January 1, 2025: TriWest takes over as the contractor for TriCare West.
- April 1, 2025: Deadline to submit 2024 claims to HealthNet Federal Services.
- June 30, 2025: Referrals, authorizations, and HealthNet’s portal access expire.
Do I need to re-credential with TriWest?
Yes, if you were in the process of credentialing or contracting with HealthNet and did not complete it by January 1, 2025, you’ll need to start over with TriWest.
Even if you’re already credentialed with TriCare West, you should verify your group and individual provider credentials with TriWest. Don’t assume anything!
What happens to claims from 2024?
All claims with 2024 dates of service must be submitted to HealthNet Federal Services by April 1, 2025. Claims submitted after this deadline will be denied, and TriWest will not process them.
For 2025 dates of service, claims must be sent to TriWest Healthcare Alliance.
Will existing referrals and authorizations carry over?
Yes, but only up to a point:
- TriWest will honor referrals/authorizations issued by HealthNet until the earlier of these two dates:
- The referral’s expiration date.
- June 30, 2025.
After June 30, 2025, you’ll need to request new referrals/authorizations through TriWest.
How do I update clearinghouse enrollments for claims?
Contact your clearinghouse to confirm whether you need to enroll separately for:
- Claims submissions to TriWest.
- Receiving Electronic Remittance Advice (ERAs) from TriWest.
Your clearinghouse should guide you through the setup process. Don’t forget to update this information before submitting your first TriWest claims.
Do I need to update EFT (Electronic Funds Transfer) information?
Yes! EFT payments will not automatically transfer from HealthNet to TriWest. You’ll need to re-enroll with TriWest to ensure payments go directly to your bank account.
Contact TriWest for their EFT enrollment process and complete it as soon as possible.
Do patients need to switch to a new portal?
Yes. Patients must create an account with TriWest Healthcare Alliance’s portal for managing claims, referrals, and authorizations.
HealthNet’s portal will remain active until June 30, 2025, but after that, it will be retired. Encourage patients to transition to TriWest’s portal before this deadline.
Will my existing referrals/authorizations still be valid?
Yes, but only until the earlier of:
- The referral’s expiration date.
- June 30, 2025.
If you need ongoing care beyond this date, your provider will need to submit a new referral/authorization through TriWest.
Does this change affect my out-of-pocket costs?
No, your out-of-pocket costs, copays, and coverage policies under TriCare West will remain the same. This transition only affects the contractor managing claims and other administrative task
What happens if I miss a deadline?
If you miss the deadlines for submitting claims or transitioning referrals, you risk losing payments or facing delays in care. Providers won’t be reimbursed for late claims, and patients may need to reapply for expired referrals.
Where can I get more information?
Visit these official resources for the most accurate updates:
- TriWest Healthcare Alliance: https://www.triwest.com
- HealthNet Federal Services (for pending claims/referrals): https://www.healthnet.com
Who do I contact for help?
- For claims and credentialing: Contact TriWest directly.
- For existing referrals/authorizations: Contact HealthNet Federal Services before June 30, 2025.
- For general TriCare West questions: Reach out to your regional TriCare support team.
Wrapping Up The 2025 Changes of TriCare West
The 2025 changes of TriCare West have created a lot of buzz—and for good reason. Transitioning from HealthNet Federal Services to TriWest Healthcare Alliance isn’t just a name change; it’s a complete overhaul of how claims, referrals, authorizations, and payments are managed. If you’re a provider, billing specialist, or even a patient, knowing these changes is essential to avoid disruptions in care and payments.
To recap the essentials:
- HealthNet is out, TriWest is in: All claims, referrals, and authorizations now go through TriWest.
- Key deadlines:
- Submit 2024 claims to HealthNet by April 1, 2025.
- Referrals/authorizations from HealthNet will only be honored until June 30, 2025, or their expiration date—whichever comes first.
- Switch over to the TriWest provider portal before June 30, 2025, as HealthNet’s portal will be retired after this date.
- Jurisdiction shifts: Six states, including Texas, are moving from TriCare East to TriCare West.
For providers, it’s all about getting credentialed, enrolled with clearinghouses, and setting up EFT payments ASAP. Patients, on the other hand, will need to start familiarizing themselves with TriWest’s portal and ensuring their referrals and authorizations are up to date.
Your Next Steps
- Providers: Start the credentialing/enrollment process with TriWest today. Confirm your clearinghouse and EFT setups to avoid payment delays.
- Patients: Transition to the TriWest portal and double-check your referrals and authorizations for expiration dates.
- Billing Offices: Get 2024 claims out to HealthNet and gear up for 2025 submissions to TriWest.
This is a big change, but with a little preparation, you can navigate it like a pro. Got questions? Drop them in the comments or share this blog post with someone who needs to know. Let’s make the transition as smooth as possible for everyone.
Thank you for reading, and good luck with the 2025 changes of TriCare West! 🙌