Welcome to Triad Healthcare
Triad is a leading musculoskeletal health services company focused on the healthcare needs of patients with painful spine and joint conditions. We work with providers, patients, health plans, government agencies and employers to help ensure that patients with musculoskeletal pain complaints receive care that is safe, evidence-based and likely to produce a favorable outcome.
BLUE SHIELD OF CALIFORNIA / TRIAD PROGRAM
Triad has partnered with Blue Shield of California to administer its prior authorization program for Pain Management and Spinal Surgery procedures.
Triad’s role in this relationship is:
1. To work with you and your staff to efficiently receive your prior authorization requests and any medical
2. To provide credentialed, actively practicing physicians and surgeons who will review compliance between
3. To make physician and surgeon reviewers available to you to discuss prior authorization determinations to:
a. Clarify and explain clinical rationale, clinical logic and the medical evidence used in the determinations.
You should have received notice from Blue Shield of California that this program will begin on 3/5/2012. Click here for a copy of this notice.
PROCEDURE CODES: Effective 3/5/12, the following procedure codes require prior authorization. Click here for a list of procedure codes.
Blue Shield of California recommends that prior authorization be obtained before the services are delivered. Services that are performed without prior authorization will be reviewed for medical necessity retrospectively upon receipt of your claim. If the services do not meet medical necessity as defined in the medical policy, the claim will be denied.
PRIOR AUTHORIZATION FORM: Prior authorization form can be accessed by clicking here: Triad Prior Authorization Form
SUBMISSION PROCESS: Prior authorization requests, along with the patient medical records, may be submitted using Triad’s secure provider portal or via fax at Click here to pre-register.. Triad’s secure provider portal is an easy and efficient way for you to manage your prior authorizations.
MEDICAL POLICIES: Blue Shield’s medical policies that address pain management and spinal surgery are posted online at blueshieldca.com/provider.
BLUE SHIELD OF CALIFORNIA MEMBERS INCLUDED: The prior authorization process is applicable to the following Blue Shield of California members:
Please note: Any Blue Shield HMO members who have selected IPA/medical groups that are delegated for prior authorization as their provider network are not included in the new prior authorization process.
If you have any questions in advance of the live date of 3/5/2012, please contact us at (877) 282-2510.