TriWest Healthcare Alliance
Authorization Letter
Quick Reference Guide
Key Points:
TriWest Healthcare Alliance will send providers a detailed authorization letter for care after scheduling an
appointment for the Veteran.
The authorization letter will specify whether the episode-of-care is under the Department of Veterans Affairs’
(VA) Patient-Centered Community Care Program (PC3) or Veterans Choice Program (VCP).
Most authorization letters include a statement that all appropriate Medicare-covered services for the
provider’s specialty are included. This means providers DO NOT need to submit a secondary authorization
request (SAR) to add a specific CPT code, as long as the code can be found on TriWest’s list of Medicarecovered services: www.triwest.com/provider/authorization-codes.
Routine lab testing and/or X-ray services, when medically necessary, are included in all authorizations,
whether conducted in the provider’s office or by a third-party. If referring to a third-party for labs, be sure to send
the laboratory provider a copy of the authorization and instruct its staff to bill TriWest.
For more information on how providers can obtain an authorization for a Veteran, review our Appointment
Scheduling Quick Reference Guide.
What Does “Appropriate Medicare-Covered Services” Mean?
In January 2016, TriWest revamped its authorization letter to be more inclusive of medically necessary CPT codes,
increase continuity of care for Veterans and lessen the paperwork burden for providers. Most authorization letters now
include a statement that all appropriate Medicare-covered services for the provider’s specialty are included in the
authorization. This means:
Providers no longer have to submit a secondary authorization request (SAR) to add a specific CPT code if
it’s available on the TriWest list of Medicare-covered services.
The TriWest list of Medicare-covered services, organized by specialty, is available on the Provider Portal at
www.triwest.com/provider/authorization-codes.
The TriWest list of CPT codes is updated regularly.
If the CPT code in question is recorded on TriWest’s list, it’s covered as part of the authorization.
The Authorization “Face Sheet” Contains:
Whether the episode-of-care is under PC3 or VCP (also called Choice, as seen below)
The provider’s name and contact information
The Veteran’s name, date of birth and last four digits of the social security number (SSN)
The authorization number
The date of the appointment
Confidential and Proprietary
4.28.16
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TriWest Healthcare Alliance
The “Authorization Detail” Section Contains:
The approved date range that covers the full episode-of-care, listed under the “valid dates” section (outlined in
red below). If a provider needs to extend the authorized date range, submit a SAR form to TriWest.
Provider information including name, specialty, and national provider identifier (NPI)
Veteran information including name, date of birth (DOB) and SSN
Authorization number
The "Clinical Information" Section Contains:
Procedure information, to include the procedure, code range, quantity, type and specific date/time of the
appointment
The “quantity” field indicates how many visits or units are approved and the “type” field identifies if the
authorization is approved for visits or units
The “all appropriate Medicare-covered services” statement, as outlined in the first section of this guide
PLEASE NOTE: Routine lab testing and/or X-ray services, when medically necessary, are included in all
authorizations, whether conducted in the provider’s office or by a third-party. If referring to a third-party for labs,
be sure to send the laboratory provider a copy of the authorization and instruct its staff to bill TriWest.
For all other authorization questions:
Please call 1-855-722-2838, Option 3, Option 1
Confidential and Proprietary
4.28.16
2