Understanding the Referral/Authorization Request Process

TriWest Healthcare Alliance offers a convenient and secure online referral and authorization tool that enables registered users to submit requests efficiently, allowing them to concentrate on patient care. The tool provides:

• Faster response times; in most cases, your request is processed immediately
• Instant confirmation that TriWest has received your referral or authorization request
• Real time status of referral/authorization requests

The preferred way of submitting referral and authorization requests is online via the secure provider portal at www.triwest.com. Providers should submit referral and authorization requests with supporting clinical documentation for these services.
Authorizations are required for procedures listed on the Prior Authorization List (PAL) for all TRICARE beneficiaries in programs administered by TriWest; specialists are required to obtain authorization before performing any procedure listed on the PAL. Providers should submit authorization requests with supporting clinical documentation.

All services listed below, provided by TRICARE civilian providers, must be reviewed for medical necessity and require prior authorization for all TRICARE programs administered by TriWest.

LABORATORY

• Genetic Testing
• Preservation of Stem Cells

RADIOLOGY

• Brain MRI
• Breast MRI
• Spine MRI
• MRA
• Pet Scan
• Cardiac CT Angiography
• CT Colonoscopy
• Other

UNLISTED CODES

In order for TriWest to make an appropriate benefit determination, all care billed with an unlisted code(s) must include a description of the item and pricing, if available, and be prior authorized with the exception of unlisted supplies with a cumulative amount of $100.00 or less.