TRICARE

How to Get Credentialed with TRICARE West Region (TriWest Healthcare Alliance) in New Mexico

Network: Open
30-60 Days CAQH Required

Quick Overview

Timeline

30 - 60 days

CAQH

Required

Re-credentialing

Every 3 year(s)

Delegated

No

New Mexico-Specific Requirements

TRICARE's West Region is administered by TriWest Healthcare Alliance, which replaced Health Net Federal Services effective January 1, 2025 (older guidance pointing to Health Net or hnfs.com is outdated). Becoming a network provider is a two-part model: you must first be TRICARE-certified/authorized (licensed, accredited, and verified under TRICARE regulation), then sign a contract with TriWest to join the network. Submit the online "Join Our Network" interest form and a TriWest provider relations representative will follow up. TriWest follows URAC credentialing standards plus federal TRICARE requirements, verifying education, board certification, license, background, and malpractice history. Providers who participate in CAQH supply their CAQH ID; those who do not complete TriWest's Individual Provider Credentialing Application. ABA providers and Behavior Technicians are certified within 10 business days of a complete application. Recredentialing occurs every 3 years. TriWest uses Availity as its provider portal.

Step-by-Step Enrollment Process

1

Gather Required Documents

Collect all necessary credentials including your medical license, DEA certificate, malpractice insurance, NPI number, and any state-specific requirements for New Mexico.

2

Complete Your CAQH ProView Profile

TRICARE West Region (TriWest Healthcare Alliance) requires a current CAQH ProView profile. Create or update your profile at proview.caqh.org and attest within 120 days.

3

Submit Your Application

Submit your completed enrollment package to TRICARE West Region (TriWest Healthcare Alliance).

4

Track & Follow Up

Credentialing typically takes 30-60 days. Monitor your application status and respond promptly to requests for additional information.

Free Consultation

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Our specialists handle the entire TRICARE West Region (TriWest Healthcare Alliance) enrollment process: applications, follow-ups, and approvals in New Mexico.

Required Documents Checklist

Board Certification

Conditional

Required if board certified

CV/Resume

5-year work history minimum

DEA License

Conditional

Required if prescribing controlled substances

Malpractice Insurance

Current malpractice insurance certificate

Medical License

Active state medical license required

NPI Certificate

Active NPI number required

Enrollment Forms

TriWest Provider Application

Online provider application for the TRICARE West region managed by TriWest Healthcare Alliance.

Required
Online Open →

Health Net Federal Provider Agreement

Provider participation agreement for Health Net Federal Services TRICARE West network.

Required

Key Credentialing Terms

CAQH
The Council for Affordable Quality Health Care, an organization that maintains a universal provider database (CAQH ProVi...
Credentialing
The process of verifying a healthcare provider's qualifications, training, licensure, and professional background to ens...
Effective Date
The date on which a provider's enrollment or network participation becomes active, allowing them to begin billing a paye...
NPI
The National Provider Identifier is a unique 10-digit identification number issued by CMS to healthcare providers, requi...
Primary Source Verification
The process of verifying a provider's credentials directly from the original issuing source, such as medical schools, li...
Provider Enrollment
The process by which a healthcare provider applies to participate in an insurance payer's network, allowing the provider...
Re-credentialing
The periodic process, typically occurring every three years, in which a provider's credentials are re-verified to ensure...

Credentialing Checklist

Make sure you have everything ready before applying to TRICARE West Region (TriWest Healthcare Alliance).

View Physician Credentialing Checklist →

Contact Information

TRICARE West Credentialing

National

1-844-866-9378

TRICARE West Claims

National

1-844-866-9378

TRICARE West Appeals

National

1-844-866-9378

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Reviewed by the PayerReady Credentialing Team

Our credentialing specialists verify every article against current CMS regulations, NCQA standards, and payer-specific enrollment requirements. See our editorial process.

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