TriWest Healthcare Alliance

TriWest Healthcare Alliance — Community Care Network administrator (Regions 4–5) — Phoenix, Arizona · triwest.com.

What it sells

Phoenix-based TriWest (founded 1996) is the VA’s third-party administrator and payer for Community Care Network Regions 4 and 5 — 14 western states, Alaska and the Pacific territories — maintaining the community provider network and processing and paying claims (through PGBA). Since January 1, 2025 it also administers TRICARE West. It states that veterans have received more than 92 million appointments through its VA network since 2013. Florida is not TriWest’s — it is Optum’s Region 3 — and this page does not pretend otherwise: TriWest is profiled because it is half of the national machine, and because it took a seat on the next generation of that machine in August 2026.

The contract and the money

VA CCN Region 4 (36C10G19D0038) and Region 5 / Alaska (36C10G21D0001); CCN Next Gen Medical awardee (Aug 31, 2026; ordering 2027–2036).

• $26 billion reported value (CCN Region 4, finalized Aug 2019) — Trade-press figure (ExecutiveBiz), not re-verified against FPDS in this build — labeled as reported. (ExecutiveBiz)
• $5 billion reported value (CCN Region 5, Alaska, awarded Oct 1, 2020) — Trade-press figure; the award itself is corroborated by TriWest’s Business Wire announcement (which states no dollar value). (ExecutiveBiz; Business Wire, Oct 8, 2020)
• $127.3 million (TriWest’s share of the $910.7M dental spread) — VA OIG estimate, FY2020–May 2024: the VA paid TriWest about $127.3M more for community dental care than TriWest paid dentists (Optum: about $783.4M). An OIG estimate of excess reimbursement under the contracts’ language — not a finding that TriWest broke its contract. (VA OIG, Feb 20, 2025)

On the record

What the government’s own watchdogs and prosecutors have published about this company, newest first. The summaries are ours; the findings are theirs.

• Program Integrity: Actions Needed to Reduce Improper Payment and Fraud Risks in VA Community Care and Medicare Advantage (GAO-26-107946) (2026-07) — Program-level: the VA reported a Community Care improper-payment estimate of $608 million for FY2025 (2.4% of outlays), and GAO found neither VA nor CMS had completed a comprehensive fraud risk assessment meeting all key elements for programs that run through administrators like this one.
• Community Care Network Outpatient Claim Payments Mostly Followed Contract Rates and Timelines, but VA Overpaid for Dental Services (VA OIG) (2025-02-20) — The joint Optum/TriWest audit: TriWest’s outpatient payments were accurate 99.8% of the time — and small error rates across both administrators still produced about $178.5 million in overpayments, while the VA paid over $900 million more to the two administrators than they paid community dental providers.

If this company is in your chain

• Tell Your Story — this site publishes documented family records. If this company is in your veteran’s chain, your documents belong on the record next to ours.
• VA OIG Hotline: 800-488-8244 — report suspected wrongdoing, inadequate patient care, or mismanagement straight to the Inspector General.

Middlemen data checked 2026-10-25 against the sources cited on this page. If a figure or a fact here is wrong, tell us — corrections are the point of this site.