> ## Documentation Index
> Fetch the complete documentation index at: https://mso.getlemma.com/llms.txt
> Use this file to discover all available pages before exploring further.

# TRICARE

> TRICARE profile: the regional contractor model, East and West, referral requirements, and enrollment.

**TRICARE** is the health program for uniformed service members, retirees, and their families. It is administered through **regional managed care support contractors**, and which contractor you deal with depends on geography.

**Payer content ages fastest of anything on this site.** Portals move, forms change, payer IDs get reassigned, and **timely filing limits are contract-specific regardless of what any table says**. Treat this page as orientation; the payer's own current documentation and **your executed contract** are authoritative. **Checked August 2026.**

## Structure

| Region           | Contractor                                                              |
| ---------------- | ----------------------------------------------------------------------- |
| **TRICARE East** | Humana Military — [humanamilitary.com](https://www.humanamilitary.com/) |
| **TRICARE West** | [tricare-west.com](https://www.tricare-west.com/)                       |

**Regional contractors change.** TRICARE contracts are periodically re-competed and reassigned, and regions have been reconfigured. Confirm the current contractor for your region before enrolling rather than relying on a saved reference.

## Plan types

TRICARE Prime (managed care, requires a primary care manager and referrals), TRICARE Select (preferred provider option), TRICARE For Life (for Medicare-eligible beneficiaries, wrapping around Medicare), and several specialized programs.

## Enrollment

Through the regional contractor. Network participation is separate from being an authorized non-network provider — TRICARE distinguishes between **network** and **non-network authorized** providers, with different payment and beneficiary cost-share consequences.

## Referrals and authorization

**TRICARE Prime is referral-driven.** Care generally requires a referral from the beneficiary's primary care manager, and specialty care frequently requires authorization from the regional contractor.

Delivering care without a required referral or authorization commonly results in non-payment, and the beneficiary may bear a higher cost-share. Verify the referral before the visit.

## Timely filing and appeals

Set by program rules rather than individual contract. Confirm current requirements with the regional contractor.

## Quirks worth knowing

* **TRICARE For Life** coordinates with Medicare — Medicare pays first, TRICARE second, for Medicare-eligible beneficiaries
* **Beneficiary categories matter** — active duty, active duty family member, retiree, and others have different rules
* **The program is federal**, so state insurance law generally does not apply
* **Rates** are generally benchmarked to Medicare


## Related topics

- [The US payer landscape](/concepts/payments/the-payer-landscape.md)
- [Payers vs insurance companies (they're not synonyms)](/concepts/payments/payers-vs-insurance-companies.md)
- [Enroll and contract with commercial payers](/guides/enrollment/enroll-with-commercial-payers.md)
- [Set up EDI, ERA, and EFT with each payer](/guides/enrollment/set-up-edi-era-eft.md)
- [File appeals](/guides/billing/file-appeals.md)
- [How to use the payer reference](/reference/payers/overview.md)
- [Payer enrollment & submission links](/reference/payers/enrollment-links.md)
- [Timely filing limits by payer](/reference/payers/timely-filing-limits.md)