Referral & Authorization Timeframes Extended by TriWest

As published in the August 3 TRICARE eNews, effective August 4, 2009, TriWest changed the validation timeframe of some referral and authorization requests from 90 days to 180 days. Changes impacted evaluation, evaluation and treatment, specialty profiles as well as other referrals/authorizations.

After 180 days, if additional services are needed or the authorized time for this authorization needs to be extended, the beneficiary will need to obtain a new authorization from the referring provider.

TriWest didn’t increase the number of visits authorized; only the amount of time the beneficiary has to use the authorized number of visits.

Note that some authorizations will continue to be valid for different periods of time as noted in the chart below:

Type of Authorization/Referral	Length of Authorization (Days)
Evaluation and Treatment	180
Maternity	312*
Home Health	60*
Durable Medical Equipment (DME)	90*
Physical Therapy (PT)	90*
Occupational Therapy (OT)	90*
Speech Therapy (ST)	90*

* The duration of these authorizations is not impacted by the August 4, 2009 change. Note: The above list includes selected examples and is not all-inclusive.

For more information, please refer to www.triwest.com/provider or call 1-888-TRIWEST (874-9378).

Published Date: 09/22/2009