Change in Urgent Request Process

We know that taking care of our TRICARE beneficiaries in a timely manner is of the utmost importance to you as well as to TriWest. However, there is a difference in an urgent request vs. a routine request.

Urgent is defined as medically necessary services required for illness or injury that would not result in further disability or death if not treated immediately, but require professional attention and have the potential to develop such a threat if treatment is delayed longer than 24 hours. Please do not indicate urgent on the referral/authorization request, unless the beneficiary truly needs care urgently. Administrative urgency or convenience is not considered urgent.

When you check the box on the TRICARE Referral/Authorization Form to indicate that the services are medically needed urgently, TriWest has been processing it as an urgent request. However, requests are sometimes submitted as urgent without sufficient clinical information to support that the services are medically urgent. This can delay the processing of other services that truly are needed urgently.

Effective March 2, 2009, TriWest is changing our process of handling urgent requests. If the request doesn’t include the clinical information supporting that the services are needed urgently and a medical necessity review is required, TriWest will contact the provider’s office requesting the supporting clinical information. This will enable us to process truly urgent requests more quickly. If the requested clinical information is not provided, the medical necessity review will be completed on the urgent request as originally submitted by the provider.

As always, we appreciate the care you render to our TRCIARE beneficiaries. If you have any questions, please contact 1-888-TRIWEST (874-9378).

Published Date: 02/26/2009