Last week, I wrote an article discussing Tricare and their policy regarding physical therapist assistants and occupational therapy assistants treating their beneficiaries. This is a must read article if you treat Tricare beneficiaries, whether the insurance is primary or secondary.
After publication of this article, I received many emails asking if TriWest is the same as Tricare and does TriWest follow the same policies as Tricare. This week, I will discuss TriWest, what’s the difference between TriWest and Tricare and does TriWest follow the same policies as Tricare for physical and occupational therapy services.
Tricare is a health benefit program for all seven uniformed services: the Army, Navy, Marine Corps, Air Force, Coast Guard, Public Health Service, and the National Oceanic and Atmospheric Administration. Tricare eligible persons include, but are not limited to:
- Active duty service members
- Spouses and unmarried children of active duty service members
- Uniformed service retirees, their spouses, and unmarried children
- Medal of Honor (MOH) recipients and/or their families.
To see the complete list, click HERE.
TriWest used to administer the Tricare program; however, no longer does so. TriWest, per their website, now serves our nation’s Veterans through the Department of Veterans Affairs (VA) Patient-Centered Community Care (PC3) Program. This program is designed to provide
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Our administrator is UHC MV. Do they follow Tricare’s rules?
If the patient has TriCare, then TriCare policies apply.
I want to really thank you for these articles on Tricare and Triwest. I do have one question though. Can a PTA treat a VA patient or a Tricare for Life patient? I will be awaiting your response.
TriCare for Life is a TriCare product so would follow the same policy as TriCare. VA is not TriCare so would not follow TriCare.
I don’t see in the link you provided where it states that PTAs are able to treat TriWest patients under the supervision of a PT. Can you assist me in finding this on their webpage?
It doesn’t state they can’t see TriWest patients.
Thank you. Very informative.
Thank you. Great info.
Can you tell me if TriWest covers the V-Go (disposable Insulin Delivery diabetes patch) product manufactured by Valeritas.
Any feedback would be greatly appreciated.
You would need to contact TriWest regarding any coverage questions.
Our region recently transitioned from TriWest to Optum as the VA’s TPA. PTA’s are still allowed to treat with this new TPA correct?
Under the VA program, physical therapists can utilize physical therapist assistant to provided physical therapy interventions under the direction and supervision of the physical therapist.
Is ChampVa considered a Triwest or Tricare product?
Great website to read: https://www.benefits.gov/benefit/318
Here is another great resource: https://www.va.gov/COMMUNITYCARE/programs/dependents/champva/CHAMPVA_faq.asp
1. Do individual state mandates or laws require Tricare to cover SLP services, or can Tricare – because it is federal – avoid state mandates?
2. Do you see Tricare allowing for reimbursement of SLPAs anytime soon?
1. They do not have to follow state mandates
I am waiting on finding a hip replacement doctor. VA says they accept the one I found and takes 2 weeks to vet. The doctor accepts Tri East but not sure about Tri west. What is the difference?