Humana Military and TRICARE: TRICARE West Transition and What It Means for Your Claims

For decades, Humana Military served as the TRICARE managed care support contractor for the West Region — covering military beneficiaries across more than 20 states, including California, Texas, and most of the western United States. In January 2024, the TRICARE West Region contract transitioned from Humana Military to TriWest Healthcare Alliance. This transition created significant confusion for millions of military beneficiaries and, for some, resulted in claim processing gaps and coverage disputes. Here is what you need to know.

What Was Humana Military?

Humana Military (a subsidiary of Humana Inc.) administered the TRICARE West Region contract on behalf of the Department of Defense for many years. As the TRICARE West contractor, Humana Military:

• Processed TRICARE Prime and TRICARE Select claims for eligible military beneficiaries in the West Region
• Managed primary care manager (PCM) assignments for TRICARE Prime enrollees
• Administered referral and authorization processes for specialty care
• Operated the nurse advice line and other beneficiary services

Humana Military was headquartered in Louisville, Kentucky (consistent with Humana Inc.'s corporate headquarters), and handled claims for active-duty service members' family members, retirees and their families, and certain reserve/National Guard members.

The 2024 Transition to TriWest Healthcare Alliance

On January 1, 2024, the TRICARE West Region contract transitioned from Humana Military to TriWest Healthcare Alliance. All TRICARE West Region beneficiaries are now served by TriWest, not Humana Military.

What this means:

• TriWest is now the contractor managing TRICARE Prime and TRICARE Select in the West Region
• Beneficiary contact information, provider network access, and claim submission channels are now managed by TriWest
• Claims for services received on or after January 1, 2024, should be submitted to TriWest

Transition period claim issues: The transition period created gaps for some beneficiaries:

• Claims submitted to Humana Military for services after January 1, 2024 may have been returned unprocessed or redirected
• Providers who had existing Humana Military network agreements needed to re-credentialing with TriWest
• Prior Authorization Denied: How to Appeal" class="auto-link">Prior authorizations issued by Humana Military expired as of December 31, 2023, and needed to be renewed through TriWest

If you received care near or after the transition date and your claim wasn't processed correctly, contact TriWest directly at triwest.com or 1-888-TRIWEST. For services before January 1, 2024 that Humana Military never processed, contact Humana Military at 1-800-444-5445 to inquire about pending claim status.

TRICARE Plan Types: Prime vs. Select

TRICARE Prime is the managed care option — similar to an HMO. Enrollees:

• Are assigned to a Primary Care Manager (PCM)
• Receive referrals from their PCM to see specialists
• Pay lower cost-sharing than TRICARE Select
• Must use network providers or get a referral for specialty care
• Active-duty family members and retirees under 65 can enroll in TRICARE Prime in areas where it is offered

TRICARE Select is the preferred-provider option — similar to a PPO. Enrollees:

• Can see any TRICARE-authorized provider without a referral
• Pay higher cost-sharing than TRICARE Prime for in-network care
• Have out-of-network benefits with higher cost-sharing
• Generally more flexible than Prime but more expensive

TRICARE for Life is available to Medicare-eligible military retirees and their dependents. TRICARE for Life serves as a secondary payer to Medicare, covering most Medicare cost-sharing. This coverage is not affected by the West Region transition — it is administered by Wisconsin Physicians Service (WPS), not Humana Military or TriWest.

Common TRICARE Claim Issues After the Transition

Provider not recognized by TriWest: If your provider was in the Humana Military network but hasn't re-enrolled with TriWest, claims may be denied as out-of-network. Ask your provider to check their TriWest enrollment status and re-credentialing if needed.

Prior authorization not transferred: Authorizations from Humana Military did not carry over to TriWest. If you had an ongoing course of treatment authorized by Humana Military, you needed to obtain a new authorization from TriWest after January 1, 2024. If treatment continued without a new authorization, the claim may have been denied — a retroactive authorization request to TriWest may resolve this.

Claims submitted to wrong contractor: Claims for pre-transition dates should go to Humana Military; post-transition dates to TriWest. Sending to the wrong contractor will result in denial or return.

TRICARE East Region: The East Region is served by Humana Military's counterpart, Humana Government Business (same parent company, different contract). If you are in the East Region, Humana Government Business is your contractor — contact information and processes differ from the West Region.

Resolving Ongoing Humana Military Claim Issues

For pre-transition claims (services before January 1, 2024) still unresolved:

• Contact Humana Military at 1-800-444-5445
• Submit written appeals to: Humana Military, P.O. Box 62509, Phoenix, AZ 85082-2509
• For Medicare-TRICARE coordination issues: contact WPS TRICARE for Life at 1-866-773-0404

For TRICARE appeals (either contractor):

1. Request a formal review of any denied claim within 90 days of the denial
2. Submit supporting documentation from your provider
3. Escalate to formal appeal if the review upholds the denial
4. TRICARE appeals beyond the initial level can go to the Defense Health Agency

When to Contact the Department of Defense

If your TRICARE claim dispute isn't resolved through the contractor appeal process, escalate to:

• Defense Health Agency (DHA): dha.health.mil
• TRICARE Beneficiary Helpline: 1-800-700-8844
• Your installation's beneficiary counseling and assistance coordinator (BCAC), who can advocate on your behalf

Fight Back With ClaimBack

TRICARE and military health insurance disputes — including transition-related claim processing gaps — can be navigated successfully with the right documentation. ClaimBack helps you build the appeal letter that presents your claim clearly.

Start your appeal at https://claimback.app/appeal.

Related Reading

• How to Write an Insurance Appeal Letter
• Common Reasons Insurance Claims Are Denied
• Internal vs. External Insurance Appeal