Struggling Due to the Recent Tricare Issues? TherapyPM can help!

Running a private practice comes with challenges like payment delays, policy changes, and administrative burdens. If you work with TRICARE, adapting to its recent management changes and new regulations can be overwhelming. Many therapists are facing increased stress, which can also impact patient care.

However, you don’t have to navigate these challenges alone. Staying informed about TRICARE updates and automating administrative tasks can help you save time and focus on patient care.

How? With Practice Management Software like TherapyPM.

This blog will explore recent TRICARE changes, their impact on private practices, and how automation can simplify daily operations.

Key Takeaways

• TRICARE Changes Are Impacting Private Practices – Recent management shifts and policy updates have led to payment delays, administrative challenges, and patient accessibility issues.
• Therapists Face Increased Administrative Burden – Private practices struggle with verifying patient eligibility, handling prior authorizations, and processing claims efficiently.
• TherapyPM Simplifies Practice Management – Automate and streamline tasks like eligibility verification, authorization requests, and claims processing to reduce workload and minimize errors.
• Improve Patient Care While Reducing Stress – By using TherapyPM, providers can focus more on patient care instead of administrative complexities.
• Stay Ahead of TRICARE Changes – Adapt quickly to evolving regulations and ensure financial stability with an efficient practice management system.

Overview of the Recent TRICARE Issues

Effective from January 2025, TRICARE has been going through major changes. This can impact both patients and providers in different ways. Not just the US military members, but even the retirees – their family members, friends, and loved ones feel the secondary impact of these changes.

Here are some of the recent challenges faced by TRICARE holders:

1.      New Management in the West Region

On January 1^st, 2025, TriWest Healthcare Alliance started managing TRICARE services in the western region of the US. Recent studies show that this transition affected around 1.5 million beneficiaries, including those who moved from the East-West Region. Due to this, some beneficiaries face difficulties setting up payment information and reaching out to customer service.

2.      Temporary Visits Granted for Specialist Visits without Prior Approval

The DHA has implemented a waiver for referral approvals in the West Region due to these changes. TRICARE Prime enrollees can now access outpatient specialty care without requiring prior authorization up to March 31, 2025. However, they must obtain a referral from their Primary Care Manager before seeking specialty care.

3.      Changes in Pharmacy Access

Due to the recent changes to TRICARE’s primary network, some pharmacies are no longer part of it. Therefore, patients have to travel farther to get their prescriptions filled.

4.      New Rules on Certain Medical Treatments

The National Defense Authorization Act for Fiscal Year 2025, signed into law in December 2024, has changed TRICARE’s medical coverage. TRICARE no longer covers some gender-affirming treatments for minors, in case, they result in sterilization. This measure has sparked debate and concern among military families and advocacy groups.

How Do the Latest TRICARE Changes Affect Private Practices?

TRICARE changes significantly impact the functioning of the private practices serving military families. It can be frustrating and stressful for therapists to handle these changes while managing patient care. Being accustomed to the normal routine of handling daily administrative tasks, and adjusting to new rules can be exhausting.

Here are some common challenges faced by private practices catering to TRICARE:

Disrupted Administrative Processes:

Studies show that the recent issues with TriWest’s platforms affected providers’ activities, such as verifying patient eligibility, submitting prior authorizations, and processing claims. Also, since providers were unaware of the TRICARE changes, they faced delays in payments, credentialing, and joining new networks.

Financial Implications:

Many private practices currently face financial pressure due to delayed payments. Due to this, they are forced to reduce their services or close the practice.

Negative Impact on Patient Care:

Some patients might face difficulties contacting their preferred providers. Especially if the provider has not integrated into the new network yet, it can be hard to reach them.

How Can TherapyPM Help You Navigate Through TRICARE Changes?

TherapyPM is an all-in-one practice management software designed to streamline daily administrative tasks for therapists. The software caters to multidisciplinary fields – ABA, mental health, physical, speech, occupational, pediatric, and marriage & family therapists.

Manual paperwork can be daunting and time-consuming, which can leave you drained without sufficient time for patients. So, TherapyPM helps reduce this burden by letting you record and upload all administrative tasks in an automated and centralized platform.

In light of TRICARE changes, which affects mainly activities like patient eligibility, prior authorizations, and processing claims, TherapyPM can help.

●       Verifying Patient Eligibility

Providers struggle with accessing updated insurance information, as inaccurate verification can result in claim rejections and service denials. TherapyPM helps you verify and request patient eligibility directly within the platform.

• Managing Patient Eligibility: Check eligibility details for your patients. Ensure you have updated the latest information before scheduling appointments or processing claims.
  • Requesting Patient Eligibility: Submit eligibility requests seamlessly to verify TRICARE coverage. Reduce claim rejections and administrative delays.

●       Prior Authorizations

As new policies arise with TRICARE, providers must navigate changing approval processes, submit required documents correctly, and track authorization statuses efficiently. Any errors or delays in this process can result in claim denials and affect patient care.

TherapyPM simplifies prior authorization management – request, track, and manage approvals within the same platform.

• Send prior authorization requests quickly and efficiently.
  • Monitor authorization statuses and receive timely updates to reduce the risk of missing approvals.
  • Once the authorization is approved, you can link it directly to claims for smooth reimbursements and fewer denials.

●       Processing Claims

Providers have faced delays in claim submissions and reimbursements, leading to financial strain and frustration. Smooth claim processing is essential to maintain a steady revenue flow and minimize disruptions in patient care.

TherapyPM has a streamlined claims management system that can help providers submit, track, and manage both primary and secondary claims efficiently. If the patient’s primary insurance covers only part of the cost, you can enable secondary claim submissions to TRICARE or other insurers.

• Monitor claim statuses in real time to reduce follow-up delays and avoid unnecessary denials.
  • TherapyPM has an automatic error detection system that alerts you when missing or incorrect details before submission. This helps prevent expensive claim rejections.

FAQs

1. How do TRICARE changes affect private practices?
   New management and policy shifts have led to payment delays, administrative challenges, and patient access issues for most private practices.
2. What are the biggest challenges for TRICARE providers?
   The biggest challenges for TRICARE providers are eligibility verification, prior authorizations, claim processing delays, and financial strain.
3. How can TherapyPM help with TRICARE updates?
   TherapyPM automates eligibility checks, streamlines prior authorizations, and simplifies claim submissions.
4. Does TherapyPM help reduce claim denials?
   Yes! It detects errors before submission, reducing rejections and speeding up reimbursements.
5. Is TherapyPM suitable for all therapy fields?
   Yes! It supports ABA, mental health, speech, occupational, physical, pediatric, and marriage & family therapy.
6. Can I try TherapyPM for free?
   Yes! You can start with a 30-day free trial and see how it aligns with your practice needs.

Conclusion

Navigating TRICARE’s changing policies can be overwhelming for private practices. However, TherapyPM can help simplify administrative tasks, ensure smoother workflows, faster reimbursements, and enhance patient care. Automate your eligibility verification, prior authorizations, and claims processing so you can allocate maximum time to patients and less to paperwork.

Stay ahead of TRICARE changes with TherapyPM – start your 30-day free trial here to streamline your practice today!