TriWest Assisting VA with Transition to CCN in Regions 1, 2 and 3

What Does this Transition Mean?

The Department of Veterans Affairs (VA) continues its transition of the Patient-Centered Community Care (PC3) program to the Community Care Network (CCN) across the country as sites in Region 3 join sites in Regions 1 and 2 in this conversion to Optum Public Sector Solutions, Inc. on a rolling schedule.

During this time, TriWest Healthcare Alliance will continue to manage its network throughout the entire nation to support Veteran care coordination until CCN is fully implemented. TriWest will assist VA for a 30-day period for each VA Medical Center (VAMC) as Optum takes over responsibility according to the VAMC CCN rollout schedule.

What Does This Mean for Providers?

There will be times when both TriWest and Optum will both be supporting a specific VAMC. It is possible that providers will receive an authorization from VA, TriWest, or Optum. Providers should bill whichever entity sent them the authorization.
Provider Billing and Payments

Authorizations

Providers need to validate the source of any authorization they receive for Veteran care prior to billing. Optum will continue transitioning providers and Veterans to CCN in Region 1 throughout early 2020.

During this transition period, TriWest still could be involved in the appointment process. If TriWest appoints, providers should send the Request for Service (RFS) to TriWest. If VA appoints, the RFS should be sent to VA. Once TriWest is no longer appointing (transition end date), please submit all RFS directly to the VA.

Locations for Urgent Care

Urgent Care/Retail Location Benefit

The Urgent Care/Retail Location benefit responsibilities will be transitioned to Optum in CCN Regions 2 and 3 no earlier than August 3, 2020. More details forthcoming. This encompasses both urgent care and urgent pharmacy prescription fills. Optum took over benefit responsibilities in Region 1 on March 18, 2020.

Information Available

More information regarding Optum’s CCN network can be found at https://vacommunitycare.com, or you can contact Optum’s CCN Provider Services Department at the following numbers:

  • Region 1: 888-901-7407
  • Region 2: 844-839-6108
  • Region 3: 888-901-6613

Visit the VA CCN website for more information regarding this transition period and CCN. 

Deployment Dates

Here are the individual VAMC deployment dates for CCN Regions 1, 2 and 3 that have been approved thus far for reference.

(* Region 1 includes VAMCs in Connecticut, Delaware, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York, North Carolina, Pennsylvania, Rhode Island, Vermont, Virginia, Washington, D.C., and West Virginia. Region 2 includes Illinois, Indiana, Iowa, Kansas, Kentucky, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota and Wisconsin. Region 3 includes Alabama, Arkansas, Florida, Georgia, Louisiana, Mississippi, Oklahoma, Puerto Rico, South Carolina, Tennessee, and the Virgin Islands [U.S.])

PLEASE VISIT THIS PAGE FOR CURRENT UPDATES!

calendar provider transition
Updated: 7/10/2020 4:16:25 PM