Follow the Proper Procedure for Photograph Requests

Photographs may be requested by TriWest for the authorization of various surgical procedures. This article details the process providers need to follow for TriWest to make an appropriate medical necessity determination and process certain types of authorization requests.

Providers should adhere to the following procedure for photographs requested by TriWest:

• Mail only the photographs to the appropriate Hub address listed below at the same time you fax the referral/authorization form to TriWest. At this time, TriWest is unable to accept faxed or e-mailed photographs.
• Make sure that the sponsor’s Social Security number and beneficiary’s name and date of birth are on the photo(s).

Fax the authorization request as usual to the appropriate fax number on the referral/authorization form.

There are no size requirements for photographs, but they should be clear enough to determine medical necessary to support the authorization request. They should be sent via mail to the appropriate Hub office. The following table lists the Hubs, the states or areas they service and their addresses:

Hub & States	Address
Northwest Hub Washington, Oregon, Alaska, Northern Idaho	TriWest Healthcare Alliance 1501 Market St. Suite 200 Tacoma, WA 98402
Southwest Hub California (except for Northern California), Nevada and Yuma, AZ	TriWest Healthcare Alliance 9275 Sky Park Ct. Suite 250 San Diego, CA 92123
Mountain Hub Arizona (excluding Yuma), New Mexico, Utah, Montana, Southern Idaho and El Paso, Texas TRICARE Prime Remote Regional Support Group (services Northern California)	TriWest Healthcare Alliance 16010 N. 28th Ave Phoenix, AZ 85053
Central Hub Colorado, Nebraska, Minnesota, Iowa, North Dakota, South Dakota, Wyoming, Missouri, Kansas	TriWest Healthcare Alliance 5475 Mark Dabling Blvd. Suite 210 Colorado Springs, CO 80918
Hawaii Hub Hawaii only	TriWest Healthcare Alliance 3375 Koapaka St. Suite C310 Honolulu, HI 96819

Once the authorization is approved, the photographs will be returned to the requesting provider’s office. If the procedure is not approved, the photos will be stored in a secure, central area at the Corporate office in Phoenix until the filing deadline for appeals has passed, then the photos will be returned to the sender.

For more information, call 1-888-TRIWEST (1-888-874-9378) or go to www.triwest.com/provider.

Published Date: 12/18/2008