Medical Records and Technical Denials Process Change – Avoid Claims Recoupments

TriWest has streamlined its communications process to make it more efficient for providers to respond to requests for medical records regarding a specific TRICARE case within a 30-day timeline. Previously, TriWest would send multiple letters and make telephone calls regarding medical records requests that frequently extended the required 30-day time limit.

If medical records are requested by TriWest, they will now send out two letters asking you to submit medical records – an initial letter and then a follow up letter 15 days later. Each letter states the need for medical records within 30 days. If you do not respond to the requests, the technical denial and recoupment processes will begin. These requests for medical records are for TriWest to review necessary documentation to ensure services are medically necessary, the diagnosis and procedural information reported is correct and matches information contained in the medical records.