Faxing to the Correct Fax Number

In order to avoid delays in processing your referral and authorization and other requests, please be sure that you are using the correct TriWest fax number. The fax numbers are listed on the bottom of the specific forms.

Request Type	Fax Number
Medical/Surgical Referral Authorization Requests
Referral/Authorization Request for Prime and Standard beneficiaries	866-269-5892
Referral/Authorization Request for TRICARE Prime Remote and TRICARE Reserve Select	866-312-5831
Referral/Authorization Request for Transplant and Cancer Clinical Trials	866-269-5758
Hospice Authorization Request	866-269-5892
Referral for 1:1:1 Program	866-576-2833
Behavioral Health Prior Authorization Requests	866-269-5892
Case Management Patient Referral Form (including Behavioral Health Case Management)	Northwest Hub – Washington, Oregon, Alaska, N. Idaho 1-866-269-5881 Southwest Hub – California, Nevada, Yuma, Arizona 1-866-269-5828 Mountain Hub – Arizona, El Paso Texas, New Mexico, Utah, Montana, S. Idaho 1-866-269-5819 Central Hub – Colorado, Nebraska, Minnesota, Iowa, N Dakota, S Dakota, Wyoming, Missouri, Kansas 1-866-312-5840 Hawaii Hub – Hawaii 1-866-269-5814 Corporate Office – All Transplant, Hospice and Cancer Clinical Trial Referrals 1-866-269-5758
Condition Management Notification Form	866-312-5839
Consult Tracking	Refer to the servicing provider referral/authorization approval letter or fax cover sheet for appropriate fax number.

TriWest is unable to accept faxed photographs. If you have any other questions about faxing to TriWest, please refer to www.triwest.com or call 1-888-TRIWEST (888-874-9378).

Published Date: 12/18/2008