Forms Updated by TriWest

Three Clinical Authorization Approval Guidelines and two injectable medication forms were recently revised by TriWest Healthcare Alliance. The guidelines were developed to help providers understand the information required for TriWest to properly evaluate referral and authorization requests to ensure that requests are medically necessary, are covered benefits, and are in compliance with TRICARE policy.

The newly amended Clinical Authorization Approval Guidelines are:

• Request for Brain MRI (this replaces the Request for MRI/CT of the Brain form)
• Request for Cervical Spine MRI (this replaces the Request for Cervical Imaging form)
• Request for Lumbar Spine MRI (this replaces the Request for Lumbar Imaging form)

Use of these guidelines is not required; however, providers will experience faster processing of their requests if these guidelines are completed and submitted with the initial referral/authorization request or if the documentation requested on the forms is included with the TRICARE Patient Referral/Authorization Form.

In addition, the Synagis form was updated in October and the following injectable medication forms were updated to include the National Drug Code (NDC) number, currently required to ensure proper claims payment:

• Injectable Medications (this replaces the Specialty Injectable Drugs form)
• Xolair injectable medication

Additional forms may be updated over the next few months. These provider forms can be found in the Find a Form section of www.triwest.com.