Behavioral Health Authorization Forms

Behavioral Health Authorization FormsVA supports evidenced-based behavioral care. The forms and education on this page align with that approach.

Medical Documentation

To support an evidence-based approach, medical documentation must be submitted for VA review. The only reason to submit medical documentation to TriWest is for a requested clinical quality review or to support a Secondary Authorization Request (SAR) where TriWest is scheduling and coordinating care. Otherwise, providers must submit all medical documentation directly to the VA Medical Center (VAMC) supervising the Veteran’s care.

Do not submit medical documentation with claims! TriWest’s claims processor, WPS Military and Veterans Health (WPS MVH) cannot review, process or resubmit your medical documentation to the Veteran’s authorizing VAMC.For information on claims submission to receive payment, please join us for a live webinar or review our Claims Quick Reference Guide.

VA requires information which is most relevant to clinical management decision-making. Please do not substitute computer-generated reports or other documents for the information requested. VA may not accept this in lieu of required clinical documentation. Instead, follow the VAMC’s requirements for medical documentation. At a minimum this will include an initial and final evaluation report.

Required: Initial Evaluation Report

After you receive your authorization for a new patient appointment and complete your initial evaluation of the Veteran, providers must complete and submit initial evaluation documentation as soon as possible, but no later than 30 days from initial appointment date. Please refer to the Behavioral Health Care Quick Reference Guide for more information.

VA requires the Veteran's identifying information (name, date of birth and Social Security number) appear on each page. You must also include your signature at the end of your report or evaluation.

Required: Completion of Episode of Care

Submit a final summary at the end of the episode of care. You should submit it as soon as possible but no later than 30 days from your final session.

  • When submitting or faxing documentation, please ensure the Veteran's identifying information (name, date of birth and Social Security number) appears on each page and that your signature is included at the end of your narrative summary.

Authorization Requests and Additional Care

Secondary Authorization Request Form

If additional care is required, you must always get that pre-authorized.

  • If the Veteran’s VAMC is managing the appointing directly, then you should submit a Request for Services (RFS) directly to the authorizing VAMC.
  • If TriWest is managing the appointing, please complete and fax a Secondary Authorization Request (SAR) form to 1-866-284-3736.
  • Please review the SAR/RFS Matrix tool for more information on which VAMCs are appointing directly.
  • With the Standardized Episode of Care (SEOC) templated authorizations, most behavioral authorizations are for six-month or 12-month time frames. This eliminates the need for most additional care requests. Providers should submit a request only if required.

Getting Started: Several sessions prior to the expiration of your initial authorization, decide whether additional sessions are required to complete your treatment plan. If yes, complete and submit a request (SAR/RFS) for these additional sessions.

  • Requests for additional sessions should be supported by a narrative summary of Treatment Progress and an updated Treatment Plan describing revised or additional problems, goals, methods and treatment. VA needs this level of detail to assess clinical need and make a utilization determination.
  • Again, the total length of your narrative summary should not exceed the space allowed on the form, approximately 1-1.5 typewritten pages for both sections combined.
    • If you prefer, attach your narrative summary sections printed on your letterhead no more 1.5 pages in length.
    • If you choose to use your letterhead, please ensure that the Veteran's identifying information (name, date of birth and Social Security number) appears on each page and that your signature is included at the end of your narrative summary.

Authorization Scope: Enter the start date for the additional care, the planned frequency of sessions and the number of additional sessions you are requesting. This is important. VA cannot approve a request without a clear understanding of the expanded scope.

  • Requests for additional treatment sessions should be for a reasonable number of sessions over a defined period of time (e.g., 12 additional weekly sessions over three months, six bi-weekly sessions over three months).
  • A new authorization must be requested for additional continued care.

Psychological/Neuropsychological Testing Authorization Requests

Psychological Testing Request Form

Common psychological testing is usually covered under an SEOC authorization. To learn more about the tests covered in your authorization, please review the Behavioral Health Authorization Letter Quick Reference Guide.

  • If you believe the Veteran needs a test not included in the authorization and the Veteran’s VAMC is appointing, please submit the RFS for additional tests directly to that VAMC.
  • If TriWest is appointing, please complete and submit the Psychological Testing Request Form. This is for psychological and/or neuropsychological assessment. Please be sure to indicate the psychometric instruments to be administered, the time requested for each, and the total number of hours in your authorization request.

Submit Claims to WPS MVH

TriWest uses WPS MVH for all claims processing. WPS MVH can accept electronic data interface (EDI) claims through your clearinghouse/billing service, via Availity or PC-ACE software.

To learn more about EDI, visit https://edi.wpsic.com/edir/home

  • To find clearinghouse Payer IDs or determine if your clearinghouse partners with WPS MVH, please visit: http://www.wpshealth.com/resources/provider-resources/edi/index.shtml or contact TriWest Provider Services at providerservices@triwest.com.
  • Mail paper claims to WPS MVH-VAPC3, PO Box 7926, Madison, WI 53707-7926. Paper claims must be on CMS compliant forms or they will be rejected.
  • Do not fax your claims to TriWest. TriWest cannot process or resubmit your claims onto WPS MVH.

Learn More! Quick Reference Guides and Webinars

We have educational tools built just for our behavioral health providers!

You can also find on-demand eSeminars and live webinars. Please view our webinar calendar and register on TriWest’s Payer Space on www.availity.com.

Updated: 5/2/2019 3:36:01 PM