Use the Latest TRICARE Referral/Authorization Form

In order to ensure that your patient’s referral or authorization request is processed as quickly as possible, submitting complete information on the correct form is critical. The TRICARE Patient Referral/Authorization Form must be submitted for a TRICARE patient requiring a specialty care referral or authorization for medical/surgical services. Please use the most current form at www.triwest.com/provider in the Find a Form section. Behavioral Health authorization request forms can be found the sub-title “Behavioral Health.”

TriWest recently updated the referral/authorization form to include a fill and print version. All you have to do is click on the “Fill & Print” icon in the Find a Form section at www.triwest.com/provider. From there, you will be directed to a fillable form where you can type in the necessary information in the appropriate fields, print out the form and fax it to TriWest. This eliminates the chance of illegible handwriting delaying the approval of the authorization request.

Please submit Current Procedural Terminology (CPT) codes for services requested. TriWest often approves "Episodes of Care" when experience shows that additional services are commonly requested subsequent to the referring provider’s initial request. Use of Episodes of Care may result in differences between the services that you request and the services that are authorized by TriWest.

The Top Reasons Why Referral and Authorization Requests are Delayed!

Delays are caused when:

• The clinical information necessary to establish medical necessity is not provided.
• CPT or diagnosis codes are not listed.
• If a specific servicing provider is being requested, the full provider name and their specialty is not listed, e.g., "Dr. Jones" as opposed to "Dr. Fred Jones, Cardiologist."
• Handwriting is illegible.

* Please note that referral and authorization approval letters and consult tracking fax cover sheets are faxed to provider offices between midnight and 3:00 a.m. daily. It's important to leave fax machines on after hours to ensure prompt receipt of these approvals.

For more information, refer to the Referrals and Authorization section of www.triwest.com/provider or call 1-888-TRIWEST (888-874-9378).

Published Date: 12/18/2008