What TriWest’s Non-Network Claims Processing Issue Means for TRICARE West Providers
TriWest says a recent operational issue processed certain TRICARE claims as non-network in error. Adjustments are underway, and updated Remittance Advice and/or EOBs will be issued as needed.
TriWest Healthcare Alliance is warning TRICARE West providers that a recent operational issue processed certain TRICARE claims as non-network in error. The warning appears as a Notice on TRICARE Claims Payments banner on TriWest’s TRICARE West Region Provider Claims Guidelines page and is current as of August 28, 2026. The banner itself does not carry a posted date.
TriWest says adjustments are underway, and updated Remittance Advice and/or Explanation of Benefits (EOB) will be issued as needed.
This is a TRICARE West / TriWest claims-processing issue. It is not a national adult day care rule, and current claims guidance does not announce a new electronic claims Payer ID or a new submission format.
What TriWest says it is doing
On the current Claims Guidelines banner, TriWest states that adjustments are underway and that updated Remittance Advice and/or EOBs will be issued as needed.
If a recalculated claim results in an overpayment of cost shares by the beneficiary, TriWest says providers should refund the beneficiary promptly.
Who it affects
The current notice is for TRICARE West providers whose claims were processed as non-network in error. It does not say every TRICARE West claim is affected, and it does not apply to providers who do not bill TRICARE West.
TriWest first published a dated Notice on TRICARE Claims Payments in the December 2025 Provider Pulse and repeated it in the January 2026 Provider Pulse. Those issues described a systems processing error that incorrectly processed certain claims as non-network instead of in-network.
What a remittance may show
A Remittance Advice or EOB for an affected claim may not match expected in-network processing. The current banner says updated Remittance Advice and/or EOBs will be issued as needed.
The January 2026 Provider Pulse said the earlier error resulted in incorrect payments or overpayments, and that cost shares and catastrophic caps may also be affected.
What to do
Compare the Remittance Advice or EOB to TriWest’s current Notice on TRICARE Claims Payments. The current banner does not tell providers to resubmit claims for this issue.
Official source
Read the current banner on TRICARE West Region Provider Claims Guidelines, current as of August 28, 2026.
The dated notices are the December 2025 Provider Pulse and the January 2026 Provider Pulse.
Centers that bill TRICARE West through ElderSuite should treat unexpected non-network adjudication as a TriWest processing issue, not a reason to change their submission setup. Review those claim records from the Claim Center on Reconcile Claims. See How to Reconcile Claims in ElderSuite.
ElderSuite is adult day care software for attendance, Medicaid billing, nursing documentation, and CACFP. You can try it free for 30 days.
Start a Free Trial
