Can You Outsource TRICARE, VA Community Care, and Union Plan Billing?

These payers share one trait that decides how they bill: the program is public, but the desk you deal with is usually a contractor. TRICARE is the Defense Health Agency’s program for uniformed service members, retirees, and their families, administered regionally, Humana Military in the East and TriWest in the West since January 2025. VA community care pays outside providers to treat veterans, but only on a VA referral, with claims handled by the network’s administrators, Optum and TriWest, rather than VA itself. CHAMPVA is a separate VA program for certain dependents and survivors. FEHB covers federal employees through dozens of competing carriers, so the card names an insurer, not the government. States run their own versions for public employees, CalPERS in California among the largest, and union members are often covered by Taft-Hartley trust funds, jointly managed labor-management plans that are typically self-funded and run by a fund office or TPA. Different programs, one billing rule: find the administrator first.

Our authorization specialists confirm the requirement during eligibility, submit through the regional contractor’s portal, chase the determination, and log the approval where billing will find it, the same workflow behind our dedicated TRICARE prior authorization service. The complexity we take off your desk: TRICARE runs two gates, not one. Referrals are a plan-design feature, Prime enrollees generally need one from their primary care manager for specialty care, while Select enrollees largely self-refer, and prior authorization is a separate medical-necessity review that either plan can require for defined services. Both are worked through the regional contractor, Humana Military or TriWest, each with its own portal and forms, and the answer changes when the patient moves, changes plans, or the region boundary shifts. Keeping a current answer, per plan and per service, to where does this request go and what does it need is exactly what a dedicated specialist has the time to do. Working those portals is administrative routing, not clinical judgment; medical decisions stay with your providers and the contractor.

The rest of the government-payer landscape is a routing exercise, and routing is desk work we staff. FEHB, the federal employees’ program, is not a payer at all from a billing standpoint: the member picks a carrier, and you bill that carrier under its rules, with the Blue Cross Blue Shield Federal Employee Program the most common card, covered in depth on our BCBS payer page. CHAMPVA is VA’s own program for certain dependents and survivors of disabled or deceased veterans, administered by VA and separate from both TRICARE and community care, so it gets its own account setup rather than a TRICARE template. Indian Health Service care involves federal and tribal facilities and purchased/referred care authorizations for outside treatment. State and public-employee plans, CalPERS in California, PEEHIP in Alabama, ERS in Texas, OPERS in Ohio, SEGIP in Minnesota, cover government workers through contracted carriers and TPAs, so the working payer is the administrator on the card. CHIP accounts route through the state’s program rules, covered on our Medicaid payer page. Our specialists verify each of these before the visit, document the administrator and filing rules on the account, and work the follow-up on the same cadence as every other queue.