Avoid Delays with Your Prior Authorization Requests

Processing for prior authorization requests can be delayed when medical necessity review is required for clinical determination if insufficient clinical or no clinical information is received from a provider. TriWest has modified its process to request additional clinical information. Effective March 2, 2009, when additional clinical information is necessary to make a clinical determination, TriWest will now contact the requesting provider to obtain the additional clinical information.

If the request is for non-urgent care, TriWest will fax a request for additional clinical information. The request for additional clinical information will state what is required along with the expected timeframe to return the requested information.

If the requested service(s) is for care needed urgently, home health care services or an acute care admission, TriWest may contact the requesting provider’s office by telephone to obtain the additional clinical information.

When the requested clinical information is provided, the request can be processed efficiently. If the additional clinical information is not provided within the timeframes specified, TriWest will issue a determination based solely on the information provided.

Please contact 1-888-TRIWEST (874-9378) if you have any questions.

Published Date: 02/26/2009