TriWest Extends Referral & Authorization Timeframes!
Effective August 4, 2009, TriWest is changing the validation timeframe of some referral and authorization requests from 90 days to 180 days. Changes will impact evaluation, evaluation and treatment, specialty profiles as well as other referrals/authorizations.
This change will allow a more comprehensive episode of care for those appointments that are made towards the end of the initial 90 day authorization period before making their first appointment. The revised timeframe will allow ample time for completion of care along with any follow up visits.
After 180 days, if additional services are needed, the beneficiary will need to obtain a new authorization from their primary care manager (PCM).
TriWest is
not increasing the number of visits authorized; only the amount of time the beneficiary has to use the authorized number of visits.
The benefits of this change include:
- Applicable online referral and authorization requests will also be 180 days. Currently, many online requests are valid for 90 days while some fax requests are valid for longer periods of time resulting in less work for both referring and servicing providers.
- Reduced number of urgent follow-up requests due to expired referrals and authorizations
- Increased ease of obtaining necessary care
- Ample time for completion of care before expiration of the referral or authorization
Note that some authorizations will continue to be valid for different periods of time; i.e., maternity authorizations are valid for 312 days, home health for 60 days, chemotherapy for 365 days, etc.
For more information, please refer to
www.triwest.com/provider or call 1-888-TRIWEST (874-9378).
Published Date:
08/03/2009
