Guest guest Posted August 16, 2012 Report Share Posted August 16, 2012 For those of you who take tri care prime; when we send a patient to the specialists , do we as pcp have to get the prior auth? The specialists here are saying I have to do this but the prior auth for tricare asks a date for the visit . How would I know the date of the visit to the specialist ? Confused Ardiana M. Teran Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 16, 2012 Report Share Posted August 16, 2012 Probably a matter of semantics…..you don't get " prior auth " but a referral to send the patient to the specialist. You can do it online, or there is a paper referral form that you can fill out and fax. You will likely have a different Tricare provider than we do, otherwise I would send you the link (we use TriWest). I have never been asked to do a prior authorization, which is what the specialist needs to do in order to perform any procedures. Once the specialist has the referral, they should be doing the rest. Good luck, For those of you who take tri care prime; when we send a patient to the specialists , do we as pcp have to get the prior auth? The specialists here are saying I have to do this but the prior auth for tricare asks a date for the visit . How would I know the date of the visit to the specialist ? Confused Ardiana M. Teran -- Pratt Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 16, 2012 Report Share Posted August 16, 2012 Oh ok, I think I meant referral.thank you for your help:)Ardiana M. Teran Probably a matter of semantics…..you don't get "prior auth" but a referral to send the patient to the specialist. You can do it online, or there is a paper referral form that you can fill out and fax. You will likely have a different Tricare provider than we do, otherwise I would send you the link (we use TriWest). I have never been asked to do a prior authorization, which is what the specialist needs to do in order to perform any procedures. Once the specialist has the referral, they should be doing the rest. Good luck, For those of you who take tri care prime; when we send a patient to the specialists , do we as pcp have to get the prior auth? The specialists here are saying I have to do this but the prior auth for tricare asks a date for the visit . How would I know the date of the visit to the specialist ? Confused Ardiana M. Teran -- Pratt = Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 16, 2012 Report Share Posted August 16, 2012 Yeah referral yes- sned a note as you would always do anyway ONe note inclided the upin npi yadda yadd saying I refer SMith for 99 visits onver 1 yr date of visit___prior auth?? could this be a medicare advantage plan not ? The specialist should be called while the patietn is there, so as to inform the patietn and write it down fo r them so they do not no showand you make the appointment for the patietn This goes on the note you then send along with supporting info DoneIf your specilaists willnot let you schedule the patient as mine won;t, you either find another who will understand what you need to do to get your work done in primary care or talk pee peer to he office manager and point out the inconsistency that they want what they will not give you odd For those of you who take tri care prime; when we send a patient to the specialists , do we as pcp have to get the prior auth? The specialists here are saying I have to do this but the prior auth for tricare asks a date for the visit . How would I know the date of the visit to the specialist ? Confused Ardiana M. Teran -- MD ph fax Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 16, 2012 Report Share Posted August 16, 2012 Hi Ardiana, I am not a Tricare expert, but I am a Tricare Prime subscriber. I have always had a referral from my PCP (a physician in a Military clinic) to go to a specialist (cardiologist, urologist, diabetic eye exam, x-ray) and only pay the copay. The one time that I got a diabetic eye exam without a referral, I had to pay the additional cost of going out of network. I cannot say what would have happened if I had gone to a Tricare provider without the referral. When I have gotten referrals, they seen to always be good for an initial visit and multiple follow ups, but expire in six months…usually always before the specialist want to see me again. So, I just call and my PCP submits another request. Perhaps making these requests is easier since my doctor is in a Military clinic. MY PCP told me this will change when I turn 65 and transition to Tricare for Life. Then since Medicare is then my primary insurer and Tricare is secondary, I will not need a referral anymore. Bill G. From: [mailto: ] On Behalf Of ArdianaSent: Wednesday, August 15, 2012 22:27To: IMPSubject: Tricare For those of you who take tri care prime; when we send a patient to the specialists , do we as pcp have to get the prior auth? The specialists here are saying I have to do this but the prior auth for tricare asks a date for the visit . How would I know the date of the visit to the specialist ? Confused :(Ardiana M. Teran Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 17, 2012 Report Share Posted August 17, 2012 Hi BIll. I got what you are saying regarding that, I bet when you are a physician in a military clinic you may have plenty of staff helping you and supporting you ( paid by the military and feds). When we are it, in the clinic, Ardiana tried to create a clinic profile/account on line ( it was Tricare west, since the patients were from Colorado) and it was impossible to do it. They were asking for Claim number to even create a profile, she tried to call and spoke to bunch of air heads and no help. Ardiana asked to have a form to be fax to us, they did and then we filled the info and guess what? they returned because it needed full name of the patient, SS#, DOB, ICD codes etc. When I read the form all that info was clearly stated there. No wonders nobody takes tricare in my area, You have to have a football team dealing with this stupid regulations. I do not know if it is the Tricare west, because I had another one that I sent created a profile online and it went with no problem. I seriously thinking not take tricare anymore, think about it, all the hours that I had to spent just to send a freaking referral that I sent via EMR in 5 minutes with no issues. Hi Ardiana, I am not a Tricare expert, but I am a Tricare Prime subscriber. I have always had a referral from my PCP (a physician in a Military clinic) to go to a specialist (cardiologist, urologist, diabetic eye exam, x-ray) and only pay the copay. The one time that I got a diabetic eye exam without a referral, I had to pay the additional cost of going out of network. I cannot say what would have happened if I had gone to a Tricare provider without the referral. When I have gotten referrals, they seen to always be good for an initial visit and multiple follow ups, but expire in six months…usually always before the specialist want to see me again. So, I just call and my PCP submits another request. Perhaps making these requests is easier since my doctor is in a Military clinic. MY PCP told me this will change when I turn 65 and transition to Tricare for Life. Then since Medicare is then my primary insurer and Tricare is secondary, I will not need a referral anymore. Bill G. From: [mailto: ] On Behalf Of ArdianaSent: Wednesday, August 15, 2012 22:27To: IMPSubject: Tricare For those of you who take tri care prime; when we send a patient to the specialists , do we as pcp have to get the prior auth? The specialists here are saying I have to do this but the prior auth for tricare asks a date for the visit . How would I know the date of the visit to the specialist ? Confused :(Ardiana M. Teran = Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 17, 2012 Report Share Posted August 17, 2012 my tricare have given me no problem although there is a specific tricare here (forget what it is) that my husband said before not to take because it was a pain.. i think it was for active duty and their families > > > > > Hi Ardiana, > > > > > > > > I am not a Tricare expert, but I am a Tricare Prime subscriber. I have always had a referral from my PCP (a physician in a Military clinic) to go to a specialist (cardiologist, urologist, diabetic eye exam, x-ray) and only pay the copay. The one time that I got a diabetic eye exam without a referral, I had to pay the additional cost of going out of network. I cannot say what would have happened if I had gone to a Tricare provider without the referral. When I have gotten referrals, they seen to always be good for an initial visit and multiple follow ups, but expire in six months…usually always before the specialist want to see me again. So, I just call and my PCP submits another request. Perhaps making these requests is easier since my doctor is in a Military clinic. MY PCP told me this will change when I turn 65 and transition to Tricare for Life. Then since Medicare is then my primary insurer and Tricare is secondary, I will not need a referral anymore. > > > > > > > > Bill G. > > > > From: [mailto: ] On Behalf Of Ardiana > > Sent: Wednesday, August 15, 2012 22:27 > > To: IMP > > Subject: Tricare > > > > > > > > > > > > For those of you who take tri care prime; when we send a patient to the specialists , do we as pcp have to get the prior auth? The specialists here are saying I have to do this but the prior auth for tricare asks a date for the visit . How would I know the date of the visit to the specialist ? Confused > > > > Ardiana M. Teran > > > > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
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