​​​​​​​TAR-Free Process (For Non-Designated Public Hospitals and Private Hospitals)

Overview

The Superior Systems Waiver (SSW) describes the utilization review process for acute inpatient hospitals that serve fee-for-service Medi-Cal patients.  It specifies how the non-designated public hospitals and private hospitals will transition from the current use of treatment authorization requests (TAR) for most hospital stays to the use of their own utilization management systems using nationally recognized, evidence-based medical criteria.​

In this new approach termed the TAR-Free process, DHCS will conduct post-payment clinical and administrative monitoring and oversight. This utilization management method is being used by California’s 21 designated public hospitals 66 non-designated public and private hospitals.

The TAR-Free process relies on program staff being granted virtual access into a hospital Electronic Health Record (EHR) system to review medical records for specific cases. DHCS is working on an updated method that will take advantage of industry technologies and make the entire process easier for everyone involved. The new approach will use standards-based electronic data exchange so DHCS staff can review case records without using virtual access.​

As a first step, DHCS is working to join the California Trusted Exchange Network (CTEN), which will allow us to connect with health information exchange (HIE) providers around California. To learn more about these efforts, please visit the DHCS Clinical Data Collection project webpage.

Please direct your comments, questions, and suggestions regarding the TAR-Free process to the following Clinical Assurance Division (CAD) email address:  DRGTARFree@dhcs.ca.gov​

Superior Systems Waiver website