Change for Non-Diagnosis Related Groups (DRG) Acute Care Medical/Surgical Admissions

Effective March 2, 2009, TriWest will request clinical documentation for medical review upon notification of urgent/emergent non-DRG acute care medical/surgical admissions. 

Facilities will be contacted and asked to provide clinical information for admissions either by telephone or fax. The clinical information requested will include the reason for admission and discharge plan.

If the requested clinical information is not received within the timeframe specified in the request, the facility will receive approval for a one-day admission.

The prior authorization process for non-emergent/non-urgent admissions and continued stay reviews remains unchanged.

As always, we appreciate your participation with the TRCIARE program. If you have any questions, please contact 1-888-TRIWEST (874-9378).

Published Date: 02/26/2009