TriWest Deadline Calculator
Pick the program, then enter the date of service (or the discharge date for an inpatient stay). Add the date on the claim decision to see the reconsideration deadline.
180-day limit per TriWest's VA CCN billing rules; one-year limit per TRICARE. Reconsideration windows per TriWest provider guidance. For any other payer, use the TFL and AFL calculator.
Two Programs, Two Deadlines
TriWest Healthcare Alliance runs two separate programs, and they do not share rules. Most TriWest timely filing denials happen because a biller used the TRICARE one-year limit on a VA claim that only had 180 days.
| VA Community Care Network (CCN) | TRICARE West Region | |
|---|---|---|
| Who the patients are | Veterans referred by the VA | Active duty families, retirees and their families |
| Where TriWest runs it | CCN Regions 4 and 5 | The West Region, since January 1, 2025 |
| Timely filing limit | 180 days from the date of service, or discharge for inpatient care | 1 year from the date of service, or discharge for inpatient care |
| Payer ID | TWVACCN (medical); CDCA1 (dental, Delta Dental of California) | 99726 |
| Claims processor | PGBA | PGBA |
| Must have | An approved VA referral or authorization number | A TRICARE-authorized provider; referrals for Prime plans |
| Reconsideration window | 90 days from the claim decision | 90 days from the remittance |
Both programs use PGBA to process claims, which is part of why they get mixed up. The payer ID is what sends the claim to the right program.
VA Community Care Network Claims
- File within 180 days. TriWest says claims past 180 days are denied for timely filing automatically, without further review.
- Include the VA referral or authorization number. PGBA only processes CCN claims tied to an approved referral. Put it in the prior authorization field (box 23 on the CMS-1500).
- Bill only what the referral covers. Check the dates, services and number of visits on the referral before the visit.
- Use payer ID TWVACCN. If your clearinghouse already sends other claims to PGBA, it still needs this payer ID set up for CCN.
- Paper claims go to TriWest VA CCN Claims, PO Box 108851, Florence, SC 29502-8851, per TriWest's claims guidance. Electronic filing is faster and gives you proof of submission.
Is your patient in a TriWest region?
The VA's community care page, updated October 20, 2026, lists TriWest for Regions 4 and 5 and Optum for Regions 1, 2 and 3. If the VA referral came from a Regions 1 to 3 facility, the claim goes to Optum, not TriWest. Care billed straight to the VA, outside the network, uses VA payer ID 12115 for medical claims and 12116 for dental.
Disputing a VA timely filing denial
You can ask for reconsideration within 90 days of the claim decision. For a timely filing denial, you need proof that the claim was first sent within 180 days to a VA payer, such as TriWest, Optum or the VA. Clearinghouse acceptance reports are the best proof, so keep them.
TRICARE West Claims
- File within one year of the date of service or discharge. TriWest strongly recommends filing within 30 days.
- Use payer ID 99726. TriWest's EDI help desk at PGBA is 1-800-259-0264.
- Other health insurance pays first. TRICARE pays after other group coverage, but before Medicaid.
- Late claims are denied, but a timely filing waiver can be requested when you can document the reason.
For the full TRICARE rules, East and West, see our TRICARE timely filing and billing guide.
Common TriWest Denials and Fixes
| Denial | Usual cause | Fix |
|---|---|---|
| CO-29 | Filed after 180 days (VA) or one year (TRICARE) | Reconsideration with proof of first timely submission |
| CO-197 | Missing or invalid VA referral or authorization | Get the right referral number and resubmit |
| CO-109 | Sent to the wrong administrator or program | Check the region and program, then resend |
| CO-22 | TRICARE patient has other health insurance | Bill the other plan first |
Tips to Avoid TriWest Denials
- Set up both payer IDs in your system, and label them clearly as VA CCN and TRICARE West.
- Track the 180-day VA deadline on its own. Do not let it share a one-year rule with TRICARE.
- Save every clearinghouse acceptance report. It is your proof if a timely filing denial comes back.
- Check the VA referral before the visit, not after the claim denies.
Sources: U.S. Department of Veterans Affairs, Community Care provider claims page (updated October 20, 2026); TriWest VA CCN Billing and Claims guidance and PGBA EDI FAQs; TriWest TRICARE West claims guidelines.
Frequently Asked Questions
Reviewed by Hassan Raza Awan, Founder — 4+ years of hands-on U.S. medical billing experience. General billing information — verify against current CMS guidance and your payer contracts.
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