Medical Necessity Appeals

Was your pre-authorization for care of services denied because it was not medically necessary? If so, you can file a medical necessity appeal.

Who Can Appeal a Denied Authorization?

TRICARE beneficiaries, including minors
Non-network participating providers
Non-network providers when appealing a pre-admission or pre-procedure denial
Custodial parents or legal guardians on behalf of minors
The legally appointed guardian of an adult beneficiary unable to care for themselves
Beneficiary’s appointed representatives
- Please complete the Appointment of Representative and Authorization to Disclose Information form, required with the appeal.
Attorneys acting on behalf of a beneficiary or proper appealing party

You can submit an appeal through the Secure Beneficiary Portal or by downloading and submitting the Authorizations Appeals Form. The form can be submitted by fax, mail or email.

Fax: 866-852-1919
Mail:
Appeals and Reconsideration Department
P.O. Box 2636
Virginia Beach, VA 23450
Email: T5AppealsReconsideration@TriWest.com

Beneficiary’s name, address, phone number, date of birth, and sponsor’s Social Security number.
A signed Appointment of Representative form, if an authorized representative is completing the appeal
A written letter or statement outlining the reason for the appeal.
A copy of the denial letter.
Additional supporting documents or medical records