Friday, December 15, 2017

OCMA Blog

Department of Defense authorizes temporary waiver for TRICARE authorizations and referrals

As previously reported, since the transition of TRICARE managed care services from TriWest to United Health Military & Veterans (UMVS) on April 1, 2013, physicians are reporting significant delays in processing of authorizations and referral requests, which is affecting patient care.

The California Medical Association (CMA) recently surveyed members about the transition, and 30 percent of physicians surveyed reported significant delays in the processing of authorization and referral requests for TRICARE patients. While the standard timeframe for processing of authorization and referral requests is two business days for urgent request and five business days for routine requests, the payor has been weeks behind in processing of these requests. CMA has been working closely with UMVS to seek a resolution to this issue as soon as possible.

To address the delays, the Department of Defense (DoD) has waived authorization and referral request requirements for all TRICARE covered services April 1 through May 18, 2013. Physicians will not be required to seek or wait for an approval from UMVS for any covered services.

However, according to the UMVS Frequently Asked Questions (FAQ), if a practice received a denial from UMVS for a previously submitted request for a referral or authorization, the previous denial will remain in effect.

In a May 3 letter announcing the waiver, Lori McDougal, Chief Executive Officer of UMVS, directs physicians to provide a copy of the letter to patients at the time of referral to ensure the specialty physician knows the request is authorized.

CMA continues to work closely with UMVS to ensure the difficulties physician’s have experienced since the transition are resolved quickly.

For more information on the TRICARE transition, see CMA's TRICARE Transition Guide, available free to members in CMA's online resource library at www.cmanet.org/resource-library.

Questions about the waiver should be directed to UMVS Provider Services at (877) 988-9378.

Contact: CMA’s reimbursement helpline (888) 401-5911 or economicservices@cmanet.org.


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