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Our commitment to you is unwavering and we’ll fight for the privilege to continue this important work.
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Utilization Management is a process that evaluates medical necessity and appropriateness of beneficiary care through prospective, concurrent and retrospective medical review.
Condition Management is a prospective, disease-specific approach to improving health care outcomes by providing one-on-one education to beneficiaries.
Case management is a process designed to assess, plan, implement, coordinate, monitor, and evaluate the options and services necessary to meet an individual’s health care needs. Programs include medical/surgical and behavioral health case management, and specialty programs, i.e., Cancer Clinical Trials, TRICARE ECHO program, and transplants.
TriWest established this program to develop, recommend, implement, and continuously evaluate the continuum of the medical, surgical, and behavioral health care services delivered to TRICARE-eligible beneficiaries. It is designed to identify areas where care can be improved and to provide feedback to physicians and providers.
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