Use the Latest TRICARE Referral/Authorization Form

In order to ensure that your patient’s referral or authorization request is processed quickly, submitting complete information on the correct form is critical. The TRICARE Patient Referral/Authorization Form must be submitted for a TRICARE patient requiring a specialty care referral or authorization for medical/surgical services. Please use the most current form, which was recently updated by TriWest. The new form is available at www.triwest.com in the Find a Form section.

Please note that referral and authorization approval letters and consult tracking fax cover sheets are faxed to provider offices between midnight and 3:00 a.m. daily. It's important to leave fax machines on after hours to ensure prompt receipt of these approvals.

Please submit current CPT codes for services requested. TriWest often approves "Episodes of Care" when experience shows that additional services are commonly requested subsequent to the referring provider’s initial request. Use of Episodes of Care may result in differences between the services that you request and the services that are authorized by TriWest.

The Top Reasons Why Referral and Authorization Requests are Delayed!

Delays are caused when:

• The clinical information necessary to establish medical necessity is not provided.
• CPT or diagnosis codes are not listed.
• The full provider name is not listed, e.g., "Dr. Jones" as opposed to "Dr. Fred Jones, Cardiologist."
• Handwriting is illegible.

For more information, refer to the Referrals and Authorization section of the Provider Connection area of www.triwest.com or call 1-888-TRIWEST (888-874-9378).