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

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. The California Medical Association (CMA) has been working closely with UMVS to seek a resolution to this and other issues related to the transition.

To address the delays, the Department of Defense (DoD) has waived authorization and referral request requirements for all TRICARE covered services from April 1 through June 18, 2013. DoD had originally waived the requirements only until May 18, but CMA today learned that the temporary waiver has been extended through June 18. Physicians will not during that time be required to seek or wait for an approval from UMVS for any covered services.

The waiver will be in place for referrals received through June 18, 2013, for care with dates of service of April 1, 2013, through September 15, 2013. Referrals made during the waiver period with anticipated dates of service of September 16 and beyond will need authorization. Physicians are urged to call UMVS at (877) 988-9378 to arrange for such authorization so that claims for those services are paid correctly.

However, if a practice received a denial for a previously submitted request for a referral or authorization, that denial will remain in effect.

In a May 3 letter announcing the waiver, physicians are directed to provide a copy of the letter to patients at the time of referral to ensure the specialty physician knows the request is authorized.

Questions about the waiver should be directed to UMVS Provider Services at (877) 988-9378. To view the notice on the UMVS website, click here.

For more information on the TRICARE transition, see CMA's TRICARE Transition Guide, available free to members in CMA's Online Resource Library.

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