TRICARE credentialing for Texas behavioral health providers

East vs West: which contractor is yours

TRICARE, the health program for service members, retirees and their families, is run by the Defense Health Agency through regional contractors under the "T-5" contracts. You credential with the contractor for the region where you practice.

TriWest's T-5 West contract (HT940223C0002) was awarded in December 2022, and care under it began January 1, 2025 (TriWest's TRICARE West provider handbook). If you see clients in more than one state, check each location's region on TRICARE's region-change page.

What changed for Texas in 2025

• New region: Texas moved from East to West on January 1, 2025 (TRICARE contract transition FAQ).
• New West contractor: TriWest replaced Health Net Federal Services as the West region contractor.
• Authorizations carried over: TriWest said it would honor approved referrals and authorizations from the previous contractor for their duration.
• Contracts didn't automatically carry over: professional associations reported that many providers had to sign new agreements with TriWest, some with proposed rate reductions (ASHA's summary for providers). If you were a TRICARE network provider in Texas before 2025, confirm with TriWest that you have a current TriWest agreement and the rates you expect.

Network, certified and authorized

TRICARE pays only providers who meet its rules for their provider type (TRICARE calls them authorized or certified providers). On top of that, a network provider signs an agreement with the regional contractor and accepts its negotiated rates, and network providers are the ones the contractor lists and refers members to. For a practice or program that wants a steady flow of military families, the network is the goal. Read the network and non-network sections of TriWest's handbook before you decide.

Individual clinicians

• Check that TRICARE recognizes your license type. TRICARE sets its own qualification rules for each kind of mental health clinician, and they don't always match a Texas license one for one. Find your provider type in TriWest's handbook before you file.
• Have the standard packet ready: license, individual and group NPIs, W-9 and IRS letter, malpractice declarations page, CV with month and year for every job, and diplomas. It's the same folder our credentialing service builds once for every plan.
• Groups: the group contracts with TriWest, and each clinician is credentialed and linked to the group's tax ID and NPI so claims pay the group. A missing link is a common reason a new clinician's claims deny.
• Medicare enrollment is a separate program, but many TRICARE beneficiaries over 65 also have Medicare. LPCs and LMFTs can now enroll; see our Medicare guide for LPCs and LMFTs.

IOP and PHP programs: participation agreement and accreditation

TRICARE pays for intensive outpatient and partial hospitalization care only in programs that meet its institutional rules. TRICARE's regulation (32 CFR 199.2) defines an IOP as a setting that can provide an organized day or evening program for people who don't need 24-hour care, and the Defense Health Agency's TRICARE Policy Manual has a participation agreement for IOPs and a separate one for PHPs. The IOP agreement requires the program to sign it and to be accredited (TRICARE Policy Manual, IOP participation agreement).

• Accreditation comes first. The accreditors programs usually use for TRICARE are the Joint Commission, CARF and COA; confirm the current accepted list with TriWest before you choose. Comply's Joint Commission behavioral health checklist and CARF survey prep guide show what each survey looks at.
• The Texas license comes before that. A Texas SUD IOP or PHP needs its HHSC chemical dependency treatment facility license before it treats anyone, and an accreditor surveys a program that's already serving clients and has charts. So the order is: license, open, accreditation, then TRICARE. Our guide to starting an IOP or PHP in Texas lays out the full sequence.
• Budget for it. On the program roadmaps we run, the TRICARE application doesn't start until the accreditation decision arrives, and we budget about 120 days from there. Plan your first year's payer mix with commercial and Medicaid contracts, not TRICARE.
• Medicare doesn't fill the gap. Freestanding IOPs and PHPs generally can't bill Medicare for those levels of care, which is one reason TRICARE matters to programs near military communities.

The Program Launch + Accreditation package is built for exactly this path: it carries a new program through the license, opening and a Joint Commission or CARF survey, so accreditation-only plans like TRICARE are open to you at the end.

How to apply, step by step

1. Confirm the region for every location (Texas is West) and that TRICARE recognizes your provider type or program type.
2. Gather the packet: licenses, NPIs, W-9 and IRS letter, malpractice and liability certificates, CV and diplomas for clinicians; for a program, the HHSC license, accreditation award letter, policies and the organization's ownership details.
3. Request to join through the provider section of TriWest's TRICARE West site, choosing individual, group or facility.
4. Programs: complete the IOP or PHP participation agreement TriWest sends for your level of care.
5. Answer requests quickly. We follow up on every application every two weeks until there's a decision.
6. Review the agreement before you sign: the rates for your codes, the timely filing limit, termination terms and the effective date. You sign the agreement yourself.
7. Get the effective date in writing, load it in your EHR, and don't treat TRICARE members as in network before it.

After you're in

• Verify eligibility and authorization every admission. TRICARE plans (Prime, Select and others) have different referral and authorization rules. The VOB checklist and the prior authorization guide cover what to ask and how to keep reviews on schedule.
• Keep accreditation current. A program whose accreditation lapses no longer meets the participation agreement. Keep the recurring work on a schedule; Comply's compliance calendar lists it.
• Report changes (new address, new clinician, ownership change) to TriWest as they happen.

TRICARE isn't VA Community Care

Veterans' care paid by the VA runs through the separate VA Community Care Network, with its own contractors, applications and authorizations. Joining TRICARE doesn't make you a VA community provider, and the reverse is true too. Veterans need a VA referral and authorization before care starts.

Getting help

Our credentialing service handles TRICARE alongside your other plans: a clinician's application is $175 per plan, and a program's facility contract with TRICARE is $450 per plan, including the organization application, site visit preparation and a contract and rate review checklist.

Questions

More credentialing guides: Medicare for LPCs and LMFTs · Texas Medicaid: TMHP and managed care · Credentialing services and prices · IOP / PHP Program Launch

Sources

Checked October 24, 2026.

1. TRICARE, Contract Transition Frequently Asked Questions (Texas and five other states moved to the West region January 1, 2025). tricare.mil
2. TRICARE, Changes to TRICARE regions. tricare.mil
3. TriWest Healthcare Alliance, TRICARE West Region Provider Handbook (T-5 contract HT940223C0002). triwest.com
4. Defense Health Agency, TRICARE Policy Manual, Chapter 11, IOP participation agreement (32 CFR 199.2 definition; participation agreement and accreditation). manuals.health.mil
5. ASHA, "What TRICARE Providers Need to Know About TriWest Taking Over the Expanded West Region in 2025." asha.org
6. MOAA, "What the New TRICARE Contract Will Mean for Your Earned Benefit in 2025." moaa.org
7. U.S. Department of Veterans Affairs, Community Care. va.gov

This guide is general information. Cima Consulting isn't a law firm or an accounting firm. TRICARE, the Defense Health Agency and TriWest make their own decisions; we don't guarantee approvals, rates or dates.