Behavioral Health Authorization Forms
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Behavioral Health Authorization Forms

Behavioral Health Authorization FormsVA supports evidenced-based behavioral care. The forms and education on this page align with that approach.

Medical Documentation

To support an evidence-based approach, medical documentation must be submitted for VA review. The only reason to submit medical documentation to TriWest is for a requested clinical quality review or to support a Secondary Authorization Request (SAR) where TriWest is scheduling and coordinating care. Otherwise, providers must submit all medical documentation directly to the VA Medical Center (VAMC) supervising the Veteran’s care.

Do not submit medical documentation with claims! TriWest’s claims processor, WPS Military and Veterans Health (WPS MVH) cannot review, process or resubmit your medical documentation to the Veteran’s authorizing VAMC.For information on claims submission to receive payment, please join us for a live webinar or review our Claims Quick Reference Guide.

VA requires information which is most relevant to clinical management decision-making. Please do not substitute computer-generated reports or other documents for the information requested. VA may not accept this in lieu of required clinical documentation. Instead, follow the VAMC’s requirements for medical documentation. At a minimum this will include an initial and final evaluation report.

Required: Initial Evaluation Report

After you receive your authorization for a new patient appointment and complete your initial evaluation of the Veteran, providers must complete and submit initial evaluation documentation as soon as possible, but no later than 30 days from initial appointment date. Please refer to the Behavioral Health Care Quick Reference Guide for more information.

VA requires the Veteran's identifying information (name, date of birth and Social Security number) appear on each page. You must also include your signature at the end of your report or evaluation.

Required: Completion of Episode of Care

Submit a final summary at the end of the episode of care. You should submit it as soon as possible but no later than 30 days from your final session.

Authorization Requests and Additional Care

Secondary Authorization Request Form

If additional care is required, you must always get that pre-authorized.

Getting Started: Several sessions prior to the expiration of your initial authorization, decide whether additional sessions are required to complete your treatment plan. If yes, complete and submit a request (SAR/RFS) for these additional sessions.

Authorization Scope: Enter the start date for the additional care, the planned frequency of sessions and the number of additional sessions you are requesting. This is important. VA cannot approve a request without a clear understanding of the expanded scope.

Psychological/Neuropsychological Testing Authorization Requests

Psychological Testing Request Form

Common psychological testing is usually covered under an SEOC authorization. To learn more about the tests covered in your authorization, please review the Behavioral Health Authorization Letter Quick Reference Guide.

Submit Claims to WPS MVH

TriWest uses WPS MVH for all claims processing. WPS MVH can accept electronic data interface (EDI) claims through your clearinghouse/billing service, via Availity or PC-ACE software.

To learn more about EDI, visit https://edi.wpsic.com/edir/home

Learn More! Quick Reference Guides and Webinars

We have educational tools built just for our behavioral health providers!

You can also find on-demand eSeminars and live webinars. Please view our webinar calendar and register on TriWest’s Payer Space on www.availity.com.