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Regence Blue Cross Blue Shield of Oregon
Oregon state health insurance For Physicians, Other Health Care Professionals and Facilities
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There are three TRICARE options available for eligible beneficiaries: Standard, Extra, and Prime.

  • TRICARE Standard is similar to a traditional indemnity plan with cost sharing and an annual deductible
  • TRICARE Extra is similar to a preferred provider organization (PPO)
  • TRICARE Prime is similar to a health maintenance organization (HMO)

For benefit information, please call 1 (888) TRIWEST (874-9378).
TriWest Healthcare Alliance awarded TRICARE contract

On July 13, TriWest Healthcare Alliance was awarded the contract to continue providing military families access to high quality health care and manage the 21-state TRICARE West Region for the Department of Defense (DoD). The contract enables TriWest to continue to support the DoD in meeting the health care needs of 2.7 million active duty personnel, their families and retirees. The contract includes a transition period, plus five one-year option periods for health care delivery beginning April 1, 2010.

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Claims, billing and reimbursement
Hospitals are reimbursed according to TRICARE’s diagnosis-related group (DRG) based payment methodology and Medicare guidelines with the exception of sole community hospitals which are reimbursed based on billed charges. Physicians and ancillary providers are paid according to a fee schedule called Champus Maximum Allowable Charge (CMAC).

TriWest has partnered with Wisconsin Physicians Service Insurance Corporation (WPS) to process and pay claims. For claims related questions, please call WPS at 1 (888) 874-9378. For questions related to Electronic Data Interchange (EDI), please call the WPS EDI department at 1 (800) 782-2680 (option 2).

Prior Authorization
TriWest requires prior authorization for some services. The current Prior Authorization List (PAL) is available on the TriWest Web site at www.triwest.com.

  • Referrals (only required for members with TRICARE Prime coverage)

When a primary care manager or specialist is unable to provide a specialized medical service, they  must request a referral either from the local TRICARE service center or TriWest.

Credentialing
TriWest has specific credentialing standards that are similar to commercial credentialing standards (e.g. National Committee for Quality Assurance [NCQA] or the Utilization Review Accreditation Commission).

Training
As a requirement of your contract, you or someone from your office must complete a TRICARE provider orientation within 120 days after joining the network. Orientations are available online at  www.triwest.com or via instructor-led educational seminars. Seminar schedules are available on the TriWest Web site. You may also contact your provider relations representative to arrange an orientation in your office or at a location near you. Orientations cover critical information including:

  • Claims processing guidelines
  • Referral/authorization procedures
  • Claims status and eligibility procedures
  • TRICARE benefit information
  • TRICARE Provider Handbook
  • Who to contact

Additional TRICARE resources:

Physicians and other health care professionals may also contact their provider relations representative for questions. TriWest beneficiaries should contact TriWest directly at 1-888-TRIWEST (874-9378).

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