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The document is a Secondary Authorization Request Form used to collect patient and provider information, details about the type of care requested, and clinical information necessary for obtaining prior authorization for medical services. It includes sections for patient demographics, requesting provider details, types of care and services needed, clinical documentation requirements, and discharge needs.

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Does VA still use TriWest?

We are honored to continue to support VA in serving Veterans from our current 28 state service territory, and expand across the rest of the country to ensure that Veterans have access to needed health care services when VA is unable to meet their needs directly.

Who is TRICARE Wests provider?

TriWest Healthcare Alliance is the current TRICARE West Region contractor. Learn more about how TRICARE regions changed on Jan. 1, 2025.

Are TRICARE West and TriWest the same?

TRICARE began delivering health care under its new regional contracts on Jan. 1, 2025. The TRICARE West Region contractor has changed from Health Net Federal Services, LLC to TriWest Healthcare Alliance. Use the guide below to help you understand which contractor can help you with your TRICARE-related questions.

What is the name of the TriWest insurance company?

TriWest Healthcare Alliance. TriWest Healthcare Alliance is a Phoenix, Arizona based corporation that manages health benefits under the United States Department of Veterans Affairs (VA) VAPCCC program in Regions 3, 5, and 6. On October 1, 2018, TriWests contract for VAPCCC was expanded to cover Regions 1, 2, and 4.

What is a signature on file form for TriWest?

Beneficiary Signature on File Use of the signature on file procedure is the providers indication that he or she agrees that verification of the beneficiarys TRICARE eligibility at the time of admission or at the time care or services are provided is required prior to any TRICARE payment.

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