Industry News: TriWest

Until further notice, providers should only use the sponsor's Social Security Number (SSN) in their web and EDI transactions with TriWest Healthcare Alliance (TriWest). This includes verifying eligibility, checking referral/authorization status, online claims submission and claims status.

To help you better understand the basics of the TRICARE® program to administratively care for your TRICARE patients, TriWest Healthcare Alliance Corp. (TriWest) offers a variety of educational opportunities to you throughout the year.

TRICARE eSeminars

The West Region Benefit Lookup Tool, available to registered users on the secure provider portal at www.triwest.com/provider, allows you to query whether a service is a covered benefit; whether the service requires a referral or an authorization; and whether the service needs medical review.

TriWest is presenting our latest TRICARE provider education seminars throughout the 21-state TRICARE West Region. In 2011, seminars will be held from April 4 through June 30.
For those new to TRICARE, these seminars provide basic TRICARE information and are a great opportunity to learn about the program. They can also serve as a good refresher for those who have previously attended a TRICARE seminar.
Each attendee will receive the newest TRICARE Provider Handbook and Quick Reference Guides. Updates on the latest enhanced functionality of the secure provider portal will also be covered.

For those registered providers who submit referrals and authorizations online on a regular basis, please remember to use a predetermined Request Type profile that includes your requested codes. For your convenience, TriWest has developed a list of over 100 episode of care profiles. When you select a Request Type profile, you will be able to see the procedure codes related to that episode of care. Please use the Request Type profile if the codes you are requesting are within the profile.

In order for TriWest Healthcare Alliance Corp. (TriWest) to make an appropriate benefit determination and understand what is required for a requested service, all services with unlisted codes require prior authorization. In addition, they must be submitted with a description of the service(s).

If a description is not included, TriWest will not process the referral and/or authorization, and return it to the provider. If the code is considered too vague, TriWest may send it back for additional information.

TriWest Healthcare Alliance has introduced a new tool for registered providers - online claims correspondence and Webmail. Available from the secure provider portal at www.triwest.com/provider, these tools allow registered users to electronically submit claims-specific issues and other general website inquiries directly to TriWest.

Based on requests from providers, TriWest Healthcare Alliance has improved the view status of online referrals and authorizations on the secure provider portal at www.triwest.com. We have added reason code descriptions that display information regarding a referral or authorization’s status (Approved, Not Approved, Pended or Cancelled).

TriWest Healthcare Alliance has implemented some new policies and procedures regarding the use of “Unlisted Codes” to ensure ongoing compliance with TRICARE policy.

Unlisted codes include Current Procedural Terminology (“CPT”) unlisted procedure codes as well as Healthcare Common Procedure Coding System (“HCPCS”) – Not Otherwise Classified (“NOC”), Not Otherwise Specified (“NOS”) and Miscellaneous Supply Codes.