TRICARE Contractor Changes 2025: A Guide for Healthcare Providers

TRICARE Contractor Changes: What Providers Need to Know

Important Update: TRICARE Regional Changes

As of January 1, 2025, significant changes are impacting TRICARE's regional contractor structure. These changes will affect how healthcare providers submit claims for services rendered to TRICARE beneficiaries.


Key Changes:

  • Regional Shifts: Six states will transition from the East Region to the West Region: Arkansas, Illinois, Louisiana, Oklahoma, Texas, and Wisconsin.
  • New Contractor for West Region: TriWest Healthcare Alliance will replace Health Net Federal Services, LLC. 
  • New Claims Processor for East Region: Humana Military will remain the regional contractor, however PGBA will replace Wisconsin Physician Service (WPS) as Claims Processor
Claim Submission:
West Region: Arkansas, Illinois, Louisiana, Oklahoma, Texas, and Wisconsin. Claims with a date of service in 2025 must be submitted to the new West Regional Contractor, TriWest Healthcare Alliance. Health Net Federal Services will continue to process claims with 2024 dates of service through April 30, 2025.

East Region:  Claims with a date of service of 2025 must be submitted to PGBA, and claims with a date of service of 2024 can be submitted to WPS until April 30, 2025

Impact on Claim Submission:

  • Identify the Correct Regional Contractor: Determine the beneficiary's region to ensure accurate claim submission.
  • Update Insurance Information: Update your practice management system to reflect the new regional assignments and payer IDs.
  • Electronic Claim Submission: Utilize electronic claim submission to streamline the process and minimize errors.
  • Paper Claim Submission: If necessary, submit paper claims to the correct address of the regional contractor.
  • Verify ERA and EFT Enrollment: Ensure that your practice is enrolled with the new claims processors for electronic remittance and payment.

Additional Considerations:

  • Stay Informed: Keep up-to-date with the latest information from TRICARE and your regional contractor.
  • Consult with Your Billing Software Provider: Work with your software provider to ensure seamless integration with the new contractor systems.
  • Seek Clarification: If you have any questions or concerns, contact your regional contractor or TRICARE directly.

By understanding these changes and taking the necessary steps, healthcare providers can navigate the transition smoothly and ensure timely reimbursement for services rendered to TRICARE beneficiaries

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