March 26, 2025 | By Dr. David J. Smith, Acting DHA Director
To Our Beneficiaries,
I know many of our military families are continuing to experience challenges with the stand-up of the TRICARE Fifth Generation (T-5) contracts. The new TRICARE contractors, Humana Military (Humana) in the East Region, and TriWest Healthcare Alliance (TriWest) in the West Region, have both experienced challenges since the start of health care delivery on January 1, 2025. This letter updates previous communications with all of you on actions underway, and the progress made to improve performance.
Our primary focus remains on you – our beneficiaries. We are taking actions that protect our TRICARE enrollees from adverse effects from these performance issues.
We continue to ensure every beneficiary can access the healthcare they need. DHA extended a waiver through April 30, 2025, that allows all TRICARE Prime beneficiaries, living in the West Region, referred for outpatient specialty care by their primary care manager to proceed with needed care without requiring a TriWest approval. Patients may also continue to use their existing providers, regardless of whether the provider has joined the TriWest network until this date.
We have also extended the time for beneficiaries who pay a premium for their plan to set up their payment method with TriWest until April 30, 2025. Working with TriWest, we have conducted comprehensive outreach by phone, email and mail. TriWest has an automated telephone system to receive these updates from beneficiaries and has overcome initial web portal challenges with processing these payments. Individuals can go to https://tricare-bene.triwest.com/signin to set up these payments.
Call center hold times have significantly improved in the West Region and are averaging around six to seven minutes. The TRICARE contract standard enables individuals to speak to a live agent within five minutes. Further improvement is expected, but individuals should be able to connect with customer service representatives in a timely manner.
At the end of February, both TRICARE East and West Regions experienced slower claims processing rates than are contractually required. Beneficiaries and providers are understandably frustrated by these delays in prompt payment processing. Initial technical problems were addressed, contractors allowed payments by means other than electronic funds transfers, and claims payments are now being processed closer to required standards. The Defense Health Agency is working with both contractors to ensure they meet our timeliness standards, and afford beneficiaries and providers the opportunity to check claims status online without technical issues.
I am deeply appreciative of your service and sacrifices to our nation – and we will continue to keep you informed of performance and corrective actions in administering this vital benefit for all of you.
Sincerely,
// Signed //
David Smith, M.D.
Acting Director