New Online Referral/Authorization Form Available to Providers

A new fill and print version of the TRICARE Patient Referral/Authorization Form has been developed to assist providers in completing the form. Providers are now able to complete all fields of the Referral/Authorization Form online, print the form, and submit it to TriWest via fax.

Here are links to samples of page 1 and page 2 of the new form. Please visit the Forms page on the Provider Connection at www.triwest.com/provider and click on the printer icon next to the TRICARE Patient Referral/Authorization Form to access.

The online referral/authorization form is an optional alternative to handwritten forms.

Published Date: 10/29/2008