the West Region Managed Care Support Contract to another company effective April 1,. 2013. TriWest is currently explorin
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Group Name Address1, Address 2 City, ST ZIP Dear Provider: Thank you for being part of the TriWest Healthcare Alliance (TriWest) provider network through Blue Shield of California that was developed to deliver health care services to TRICARE beneficiaries in the TRICARE West Region. For 16 years, TriWest has had the honor and privilege of serving as a Managed Care Support Contractor for the TRICARE program. As you may be aware, the Department of Defense (DoD) awarded the West Region Managed Care Support Contract to another company effective April 1, 2013. TriWest is currently exploring several business opportunities that will allow it to continue to serve military and veteran customers. The partnership with providers in building the network over the past 16 years is one of the greatest assets of a business such as ours. TriWest and Blue Shield of California are requesting your continued support by remaining a contracted provider while these business opportunities unfold. Attached is an amendment to your existing provider agreement(s) that allows your TRICARE agreement with Blue Shield of California to remain in effect past April 1, 2013. Please note that the purpose of this amendment is to retain TriWest’s provider network for potential future opportunities; it is not for the TRICARE West Region Managed Care Support Contract. When TriWest has determined the business opportunities, communication will be sent to all contracted providers with an amendment for your review that will be specific to that business, including reimbursement rates and clearly defined contractual terms. No action on your part is required at this time. If you have any questions, please feel free to contact Blue Shield at 866-296-8744. Respectfully,
Tony Verna Director, TRICARE Network Services
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TRICARE PROFILE SHEET W9/LEGAL BUSINESS NAME FEDERAL TAX ID # PRIMARY PHYSICAL ADDRESS LINE 1 PRIMARY PHYSICAL ADDRESS LINE 2 PRIMARY PHYSICAL CITY STATE ZIP PRIMARY CONTACT PERSON PRIMARY PHONE/ AUTHORIZATION FAX PRIMARY EMAIL CONTRACTOR NAME CONTRACTOR EMAIL ADDRESS BILLING ADDRESS LINE 1 BILLING ADDRESS LINE 2 BILLING CITY STATE ZIP BILLING CONTACT PERSON BILLING PHONE/FAX BILLING EMAIL
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Group Name TaxID Address Line 1 Address Line 2 City, State Zip
AMENDMENT TO TRICARE CONTRACT This amendment to the TRICARE [CONTRACT TYPE] Contract (this “Amendment”) is entered into effective as of February 1, 2013, (“Effective Date”) by and between Blue Shield of California, a California nonprofit corporation, (“Network Subcontractor”), TriWest Healthcare Alliance Corp (“TriWest”) and [Group Name] (“Provider”) (collectively referred to as the “Parties” or individually as a “Party”). This Amendment amends the TRICARE Contract (the “Agreement”) between the Parties as follows: 1. Section II, Term and Termination, Subsection A, shall be deleted in its entirety and replaced with the following. “Term - This Agreement shall commence upon the Effective Date and continue for an initial two year term. Thereafter, both Parties agree that the term of this Agreement shall automatically be extended for one-year periods unless terminated by either Party as permitted by this Agreement.” 2. Section VI, Payment to Provider, Subsection A: The following sentence shall be added to the end of the paragraph: Neither Network Subcontractor nor TriWest shall be responsible for payment of claims for services with a beginning date of service that is after the termination date of TriWest’s responsibility to administer a program (e.g. Network Subcontractor and TriWest are not responsible for payment of claims for services provided to TRICARE beneficiaries with dates of services beginning April 1, 2013 or after).
3. Section VII, General Provisions, Subsection A, Amendment: The following sentence shall be added to the end of the first paragraph: “Such amendments may include the addition of other TriWest-administered programs. In such instances, the amendment shall include a description of the program, requirements specific to the program and rate information specific to the program.” If any provision of this Amendment is deemed illegal, unenforceable or in conflict with any law of a Federal, state or local government having jurisdiction over this Agreement, the validity of the remaining sections and of the Agreement shall not be affected. Except as amended hereby, all of the terms and conditions of the Agreement remain in full force and effect. --- Signature Not Required --
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