TRICARE West provider portal, phone and payer ID quick facts
| Provider portal | https://tricare.triwest.com/provider |
|---|---|
| Provider phone | 1-888-874-9378 |
| Claims payer ID | 99726 |
| Eligibility payer ID | TRICW |
| ERA payer ID | TRICW |
| Timely filing | 365 days |
| Prior auth route | X12 278 plus provider portal |
| Last reviewed | 2026-04-23 |
TRICARE West at a glance
| Legal name | TriWest Healthcare Alliance Corporation (TRICARE West Region contractor) |
|---|---|
| Also known as | TriWest, TRICARE West Region |
| Category | Government program |
| Parent organization | Defense Health Agency (contracted through TriWest) |
| Claims payer ID | 99726 |
| Eligibility (270/271) payer ID | TRICW |
| ERA (835) payer ID | TRICW |
| NAIC company code | Not published |
| States covered | Alaska, Arizona, California, Colorado, Hawaii, Idaho, Kansas, Minnesota, Missouri, Montana, Nevada, New Mexico, North Dakota, Oregon, South Dakota, Texas, Utah, Washington, Wyoming |
| Provider portal | https://tricare.triwest.com/provider |
| Provider phone | 1-888-874-9378 |
Always verify claims-routing details against the member ID card and the payer's current EDI companion guide before submission.
Timely filing & appeals for TRICARE West
TRICARE West's standard timely filing window for participating providers is 365 days from the date of service. Plan-specific products (Medicare Advantage, Medicaid, employer groups, secondary claims) may have shorter or longer windows — always confirm against the policy linked below before disputing a TFL denial.
| Submission type | Window |
|---|---|
| In-network initial claim | 365 days |
| Out-of-network initial claim | 365 days (verify per plan) |
| Secondary / coordination of benefits | 365 days from primary EOB |
| Corrected / appeal | 90 days from denial |
Appeal levels
- Level 1: ReconsiderationFile within 90 days
Written reconsideration request within 90 days of the initial determination per TRICARE Policy Manual.
- Level 2: Formal ReviewFile within 60 days
Formal review by the TRICARE Area Office following an unfavorable reconsideration.
- Level 3: HearingFile within 60 days
Hearing before a DHA-appointed hearing officer (claims ≥ the TRICARE hearing threshold).
Source: TRICARE West provider policy. Always confirm before disputing a TFL denial — payer policies are versioned and product-specific.
Prior authorization with TRICARE West
TRICARE West accepts X12 278 prior-authorization transactions electronically. The procedures most commonly subject to prior authorization include advanced imaging, inpatient admissions, specialty pharmacy, and certain outpatient surgical procedures. Use the payer's authorization tool below to confirm requirements per CPT before scheduling a service.
TRICARE West maintains a live prior-authorization code lookup tool that supersedes any cached list. Use the provider portal or the policy documents below to confirm the current PA list before rendering a service.
Top denial reasons for TRICARE West
Per-payer denial benchmarks publish here once the QuickIntell anonymized ETL pipeline ingests sufficient TRICARE West volume. Until then, see the broader CARC reference for industry-wide remediation guides.
Electronic claims, eligibility & ERA
| Transaction | Supported | Payer ID |
|---|---|---|
| 837P / 837I claims | Yes | 99726 |
| 270 / 271 eligibility | Yes | TRICW |
| 278 prior authorization | Yes | TRICW |
| 835 ERA | Yes | TRICW |
Payer IDs vary by clearinghouse — confirm against your clearinghouse payer list (Availity, Change Healthcare/Optum, Waystar) before configuring submitter routing.
What revenue cycle teams should verify before submitting claims
- Use 99726 for TRICARE West claim submission to PGBA, and confirm eligibility/remit mappings such as TRICW in the provider's clearinghouse.
- Submit referrals and authorizations through Availity under TRICARE West/TriWest Payer Spaces.
- Secondary claims with Other Health Insurance must be submitted within the separate OHI timing rule after primary adjudication.
Common denial and routing risks for this payer
- Using legacy TRICARE West or VA CCN payer IDs after the TriWest transition.
- Missing referral or authorization requirements for Prime and specialty care services.
- Submitting OHI secondary claims outside the TRICARE West post-primary-adjudication window.
How QuickIntell supports this workflow
- Split TRICARE West claim routing from VA Community Care and CHAMPVA routing so similar government names do not collide.
- Use authorization workqueues tied to Availity referral status before releasing scheduled services.
- Track TRICARE reconsideration and appeal clocks directly from the remittance advice date.
Sources used for this guide
State coverage
TRICARE West operates in the following states. Each link opens state-level Medicaid program details, dominant commercial payers, and state-specific RCM regulations.
QuickIntell coverage for TRICARE West
- QuickRCM
End-to-end claim lifecycle automation tuned to TRICARE West's edits and adjudication patterns.
- QuickAuth
Automated prior-authorization submissions and status checks for TRICARE West services that require PA.
- QuickERA
Automated 835 ERA posting from TRICARE West with payment reconciliation and denial routing.
Frequently asked questions about TRICARE West
Where is the TRICARE West provider portal?
The TRICARE West provider portal is available at https://tricare.triwest.com/provider. Use it for eligibility checks, claim status, prior authorization workflows, appeals, and payer-specific routing updates. QuickIntell links to the payer's provider-facing portal as a reference and is not the official payer portal.
What is the timely filing limit for TRICARE West?
TRICARE West's standard timely filing limit for participating providers is 365 days from the date of service. Plan-specific products (Medicare Advantage, Medicaid managed care, employer groups) may have different windows — confirm against the payer's provider manual before disputing a TFL denial.
What is the TRICARE West payer ID?
The primary claims payer ID for TRICARE West is 99726. Eligibility (270/271) uses TRICW and ERA (835) uses TRICW. Always verify against the member ID card and your clearinghouse payer list before submitting.
Does TRICARE West accept electronic claims?
Yes — TRICARE West accepts ANSI X12 837P and 837I electronic claims through standard clearinghouses. Real-time eligibility (270/271) is supported and X12 278 prior authorization is supported.
How do I appeal a TRICARE West denial?
TRICARE West uses a 3-level appeal process. Level 1 (Reconsideration) must be filed within 90 days of the denial. Each escalation level requires the prior decision letter and supporting clinical or coding documentation. See the appeal-levels block above for deadlines and process.
How long do TRICARE West prior authorization approvals take?
TRICARE West's prior-authorization decision turnaround typically follows standard industry windows: 72 hours for urgent requests and up to 14 calendar days for non-urgent requests. Specialty drugs and high-cost imaging may extend further. Submit through X12 278 or the TRICARE West provider portal for the fastest turnaround.
What is the TRICARE West provider phone number?
Providers can reach TRICARE West at 1-888-874-9378 for claims status, eligibility verification, and authorization questions. Have the member ID, date of service, and tax ID ready before calling. Most operational tasks are faster through the provider portal at https://tricare.triwest.com/provider.
Run cleaner claims to TRICARE West with QuickIntell
QuickAuth, QuickRCM, and QuickERA are validated against TRICARE West's EDI behavior — eligibility, prior auth, claim scrubbing, and ERA posting all run on real payer rules.
Disclaimer
This page is operational reference for medical-billing professionals. It is not legal, clinical, or contractual advice. Payer policies change without notice — always verify against TRICARE West's current published documents before submission. CPT® is a registered trademark of the American Medical Association.