TRICARE Billing for Providers: Regions, Contractors, Network Status and TRICARE For Life

TRICARE billing means filing claims for the Department of Defense health program that covers active duty and retired service members and their families, through the contractor for the patient’s home region rather than through the government directly. The contractor, not TRICARE itself, enrolls providers, processes the claim and sends the remittance.

Practices near a military base bill TRICARE often. If you see only a few of these patients a year, the regional structure is the part most likely to cause errors.

Where you see it

Place	What it shows
Uniformed services ID card or Common Access Card	The patient is a TRICARE beneficiary; the DoD Benefits Number on the card is the ID to bill with, not the sponsor’s Social Security number
DEERS (Defense Enrollment Eligibility Reporting System)	The eligibility record; the sponsor’s service decides eligibility and DEERS records it
Regional contractor portal or 271 response	Plan (Prime, Select, TRICARE For Life and others), region, and whether other health insurance is on file
CMS-1500 box 1	The TRICARE checkbox; the sponsor is the insured in box 4 and 11 when the patient is a family member
Remittance advice	Issued by the regional contractor, or by WPS for TRICARE For Life after Medicare has paid

Who TRICARE covers

Eligibility comes from the sponsor’s uniformed service and is recorded in DEERS. The groups are active duty service members and their families; retired service members, retired Reserve members and their families; National Guard and Reserve members and their families; survivors; former spouses; Medal of Honor recipients and their families; dependent parents and parents-in-law; and beneficiaries who are eligible for both TRICARE and Medicare. The plan matters to the biller: TRICARE Prime works like a managed care plan with a primary care manager and referrals, TRICARE Select like a preferred provider plan, and TRICARE For Life is the wraparound for Medicare beneficiaries.

Regions and contractors in 2026

TRICARE is run in three regions, and the region is based on where the patient lives.

Region	Contractor	Notes
East	Humana Military	24 states plus the District of Columbia
West	TriWest Healthcare Alliance	26 states: Alaska, Arizona, Arkansas, California, Colorado, Hawaii, Idaho, Illinois, Iowa, Kansas, Louisiana, Minnesota, Missouri, Montana, Nebraska, Nevada, New Mexico, North Dakota, Oklahoma, Oregon, South Dakota, Texas, Utah, Washington, Wisconsin, Wyoming
Overseas	International SOS	U.S. territories and all other overseas locations

The regions changed on January 1, 2025. Six states moved from the East Region to the West Region: Arkansas, Illinois, Louisiana, Oklahoma, Texas and Wisconsin, and their contractor switched from Humana Military to TriWest Healthcare Alliance. TriWest also took over the rest of the West Region on the same date. A Texas practice enrolled with Humana Military before 2025 needs a TriWest enrollment for every claim since. A few border areas are assigned by ZIP code, so check the contractor’s lookup near a region line.

TRICARE For Life

TRICARE For Life (TFL) is Medicare-wraparound coverage for TRICARE beneficiaries who have Medicare Part A and Part B. There is no enrollment, no enrollment fee and no TFL card; the patient pays Medicare premiums and shows a Medicare card plus the military ID. For billing, Medicare is primary: you file with Medicare as usual, Medicare pays its share and forwards the claim to the TFL claims processor, which is WPS Government Services for the United States and its territories. TFL then pays the provider for covered services; you should not need to bill WPS unless the crossover fails. If the patient also has other health insurance, TRICARE pays after it; by law TRICARE pays after all other health insurance except Medicaid, TRICARE supplement plans, state crime victim compensation programs and certain other federal programs such as the Indian Health Service.

Network and non-network

Status	Meaning	Payment and balance billing
Network provider	Contracted with the regional contractor	Files the claim, accepts the TRICARE allowable as payment in full, collects only the patient’s cost share; no balance billing
Non-network, participating	TRICARE-authorized, no contract, accepts assignment on the claim	Paid directly, accepts the allowable as payment in full for that claim; no balance billing
Non-network, non-participating	TRICARE-authorized, does not accept assignment	Payment goes to the patient; may balance bill up to 115 percent of the TRICARE allowable

“TRICARE-authorized” means the provider meets TRICARE’s licensing and certification requirements and has been accepted by the contractor; it is a prerequisite for any TRICARE payment, network or not.

TRICARE, CHAMPVA and VA Community Care

	TRICARE	CHAMPVA	VA Community Care
Agency	Department of Defense	Department of Veterans Affairs	Department of Veterans Affairs
Patient	Service members, retirees, their families	Spouse and children of a veteran rated permanently and totally disabled, or who died, from a service-connected condition	The veteran, when VA arranges care outside its own facilities
Administered by	Regional contractors	VA centrally; no network	VA community care network administrators by region, under a VA referral or authorization
Overlap	A person eligible for TRICARE cannot get CHAMPVA	See our CHAMPVA article	Claims and authorizations run through VA, not a TRICARE contractor

A worked example

A retired Army sergeant, 58, with TRICARE Select lives in Texas and is treated at a freestanding center that is TRICARE-authorized but not in TriWest’s network. The practice participates on the claim. Weekly treatment management, CPT 77427, is billed at 240.00; the TRICARE allowable is 180.00 and the patient’s Select cost share is 36.00. TriWest pays 144.00 to the practice, the patient owes 36.00 and the practice writes off 60.00. Had the practice not participated, TriWest would have paid the patient, and the practice could have billed the patient up to 115 percent of 180.00, which is 207.00 in total. All figures are illustrative; cost shares depend on the plan and beneficiary category.

Eight years later the same patient has Medicare Part A and B and is covered by TFL. The practice bills Medicare; Medicare pays 80 percent of its allowed amount and crosses the claim to WPS, which pays the remaining coinsurance for a service both programs cover. No claim goes to TriWest.

What to do

• Check DEERS eligibility and the plan at every visit through the contractor’s portal or your eligibility vendor, and record the DoD Benefits Number from the card.
• Pick the region by the patient’s home address, not by your office location, and enroll with each contractor whose beneficiaries you see. Iridium Suite’s real-time eligibility check runs before the visit, which is where a patient’s new Medicare entitlement, and with it the switch to TRICARE For Life, is found.
• Bill other health insurance first. TRICARE is the payer of last resort apart from Medicaid and the other listed exceptions, and TFL always follows Medicare.
• Get the referral for Prime patients from their primary care manager before the consult and keep the authorization number on the claim.
• Decide participation deliberately. Participating means accepting the allowable; non-participating moves payment and collection to the patient.

Related terms

• CHAMPVA cards and billing
• Coordination of benefits
• Crossover claims
• Allowed amount
• Timely filing limit

Further reading: TRICARE regions; TRICARE For Life; Defense Health Agency: how TRICARE regions changed in 2025; TRICARE West Region: balance billing.