Tricare West
Overview
Tricare regional contractor (West region). Government payer serving military / dependents. Currently administered via Humana in several states, with BCBS involvement in some (e.g. Oklahoma); routing and process shift frequently.
Pain Points / Open Issues
- Rules change roughly every 6 weeks. Payer guidance on routing, submission channels, and who to contact flip-flops on a ~6-week cadence per Confluent ops. Makes SOPs stale almost as soon as they’re written.
- Direct-contact-dependent. Confluent has one productive direct contact today; the value depends on that contact staying in the role.
- Tricare team at BCBS still being stood up. A BCBS Texas rep told Medallion that the Tricare sub-department was still being built internally and experiencing significant delays (context: discussing BCBS-routed Tricare enrollments).
- Routing most recently flipped in Oklahoma (per Julie / Confluent 4/15); Humana now primary routing path, but change came ~6 weeks after the last one.
Decisions & Commitments
- 2026-04-15 — Confluent explicitly not holding Medallion to SLA on Tricare West given payer instability. Source: Melody in 15 weekly.
- 2026-04-15 — SOP update committed for Tricare West (alongside Healthspring) by 2026-04-20, followed by team retrain.
Key Facts
- Rule/routing churn cadence: ~6 weeks.
- Top-10 volume on Confluent account (recently dropped from #1 to #2 position, week of 2026-04-15).
- Cross-payer dependency: BCBS state plans route some Tricare enrollments through their own Tricare sub-teams (e.g. Oklahoma) — process consistency low.
Related Customers
Source History
- 2026-04-15 — Medallion weekly — Tricare West routing + SLA grace