The T-5 contract transition took place on January 1, 2025. In the western region, this included a change in third-party administrator from HNFS to TriWest. The transition has been fraught with challenges, including functionality and process issues across every aspect of service provision. Initially, TriWest provided little to no updates on the process, but later indicated they expected to have most issues resolved by March 31, 2025. It is now mid-to-late April, and issues continue. TriWest appears to have taken a triage approach, instead of addressing the systemic barriers impacting their systems, staff, and the TRICARE benefit as a whole. Concerns continue across all areas of service, with ABA/ ACD providers continuing to express concerns in the following areas:

• Contracting and credentialing
  ● Provider directories
  ● Adding new providers, including RBTs
  ● Availity and Care Affiliate functionality
  ● Requesting and receiving prior authorizations
  ● Authorizations for outcome measures
  ● Claims submission
  ● Claims payment, including issues with the reduced fee schedule and improper denial of claims
  for allowable concurrent billing

What does CASP need from you?

Please complete this Action Alert by sending your Federal Senator and Representative a message to make sure this issue gets the attention it deserves, to ensure continued access to care for TRICARE beneficiaries, and ensure ABA providers can remain in the TriWest network. Many providers are still going without payment 4.5 months into the year. Many beneficiaries are going without medically necessary care and services, which impacts military member readiness.