Use Profile When Submitting Online Referrals/Authorizations

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. If you can’t use a Request Type profile, you will be limited to a code range (low and high) of 10 codes. If you have two codes to enter, you should enter two different service lines, not a range with one in the low and the other in the high field. When entering a request, if the code range is more than 10 codes, the user will get an error indicating that the “allowable” code range has been exceeded and you will have to put in a code range of less than 10 codes. The user will not be able to enter the request until there is an acceptable code range. This prevents TriWest from inadvertently approving services that aren’t covered by TRICARE, and allows claims to process without stopping due to issues with non-covered services.