Provider Pulse

August 2020

TriWest CCN Transition Continues in Region 4

Summer continues its march into August as TriWest Healthcare Alliance is wrapping up its transition to Community Care Network (CCN) coverage throughout Region 4. Additionally, the Department of Veterans Affairs (VA) has new guidelines for COVID-19 viral testing. Read all about these items, and more, below.

In This Edition:

TriWest CCN Transition Continues in Region 4

The final phases of TriWest Healthcare Alliance’s transition to delivering health care under the new Department of Veterans Affairs (VA) Community Care Network (CCN) in Region 4 will be completed by the end of August. CCN will replace the Patient-Centered Community Care (PC3) program as the preferred national network VA uses to refer Veterans for care in their community.

CCN has been deployed in a phased approach, and this month’s expansion includes the remaining western states through the end of August 2020. The entire CCN Region 4 includes the western U.S. states of Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Texas, Utah, Washington, and Wyoming.

Other Relevant CCN Region 4 Information

  • VA Requiring Providers to Take Opioid Safety Training – VA now requires each individual provider within a practice or group who has a DEA number and can prescribe narcotics to Veterans under CCN to review a short opioid safety handout. VA also strongly encourages providers to complete military and Veteran culture training. To register and download VA’s opioid safety requirements and training:
    1. Visit https://train2serve.com/.
    2. Select “Register Now”.
    3. Complete the registration process.
    4. Download the Opioid Safety Initiative information.
  • PC3 information previously on the TriWest Provider portal at http://www.triwest.com/provider is shifting to the TriWest Payer Space on Availity at http://www.availity.com. Availity is now our providers’ one-stop shop to access CCN training as well as applications, quick reference guides, the Provider Handbook, and news and announcements.

Other Pertinent CCN Region 4 Information

  • Claims will continue to be sent to WPS Military and Veterans Health (WPS MVH).
  • Information previously contained on the Provider portal at http://www.triwest.com will shift to the TriWest Payer Space on Availity at http://www.availity.com
  • Availity will become your one-stop shop to access CCN training, as well as applications, quick reference guides, the Provider Handbook, and news and announcements.
  • Providers should ensure they are fully contracted with TriWest as part of the CCN network. Some providers August have received auto-amendments to their existing PC3 contracts that do not require a signature, while others need to sign an updated or new contract to continue seeing Veterans under CCN.
  • For more information, please visit https://ccn.triwest.com.

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New! VA COVID-19 Viral Testing Information

The Department of Veterans Affairs (VA) has reissued its guidelines for covering COVID-19 viral testing for Veterans, especially at Urgent Care/Retail and Emergency Care network locations. VA will pay for testing as long as it is in conjunction with a clinical visit for care.

VA’s goal is to ensure that COVID-19 viral testing, as defined by the Centers for Disease Control and Prevention (CDC), is available to eligible Veterans as widely as possible through VA health care centers or through TriWest Healthcare Alliance network providers in the Community Care Network (CCN) and Patient-Centered Community Care (PC3) program.

The following criteria describe how Veterans may be tested for COVID-19, paid for by VA:

  • To be eligible, Veterans must either be enrolled in VA health care or otherwise be eligible for VA care. See Veteran community care eligibility requirements for specifics.
    • Eligible Veterans will not be charged a copayment for COVID-19 viral testing.
  • Eligible Veterans should meet specific testing criteria, as described by the CDC and local public health department guidelines.
    • Viral testing includes nucleic acid (molecular) and antigen tests, which test for the current presence of the virus (See CDC explanation and the Food and Drug Administration [FDA] explanation for types of COVID-19 testing.).
  • VA will reimburse community providers for COVID-19 viral testing of eligible Veterans at one of the following outlets:
    • In-network Urgent Care/Retail locations, if it is in conjunction with a clinical visit for care.
    • In-network CCN providers, if an approved referral or authorization exists.
    • Emergency departments, if the visit otherwise meets criteria for VA coverage of emergency care services (either through the PC3 or CCN networks or care that is paid for directly by VA).

See the Claims Submission Quick Reference Guide for information about how to file a claim.

For updates, VA will continue to communicate with community providers through its Provider Advisor e-newsletter (click to sign up), the COVID-19 Guidance for Community Providers webpage, and TriWest’s COVID-19 Resource Page.

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PC3 Contract and Authorization Validity End Date

The Department of Veterans Affairs (VA) Patient-Centered Community Care (PC3) program will officially end on March 31, 2021. Some providers may have received PC3 authorizations with an end-date after March 31, 2021. To remedy this, TriWest Healthcare Alliance has started sending updated PC3 authorization letters with an adjusted end date of March 31, 2021, to correct any that had an end date beyond March 31, 2021.

Providers should not submit a Request for Services (RFS) to extend any of these authorizations for their Veteran patients under the PC3 program. However, contracted providers may send an RFS to VA to get a new approved referral/authorization under the Community Care Network (CCN). Only CCN-contracted providers will be allowed to deliver care to Veterans with an approved referral after March 31, 2021. If the provider is located outside of CCN Region 4 and would like to join CCN, they should contact Optum, VA’s third party administrator in Regions 1, 2, and 3.

TriWest is proud to continue supporting VA through the new CCN in Region 4.

More information about CCN can be found at http://www.triwest.com/provider or by contacting your local VA Medical Center.

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New! TriWest Can Reimburse Certain Non-Network Providers

A recent contract modification with the Department of Veterans Affairs (VA) now allows TriWest Healthcare Alliance (TriWest) to reimburse certain out-of-network providers under VA’s Community Care Network (CCN) for services provided under a CCN-approved referral.

The only applicable out-of-network providers who are eligible for this type of reimbursement are:

  • Ancillary providers when their services are provided as an adjunct to medical or surgical services provided by in-network providers; and
  • Out-of-network facility providers, at which the services are provided, and are performed by an in-network physician performing scheduled, non-emergent care.

Ancillary providers are defined as those providers who perform diagnostic or therapeutic services as an adjunct to basic medical or surgical services such as facility-based physicians, assistant surgeons, anesthesiologists, specialty physicians, radiologists, pathologists, and emergency care physicians.

Out-Of-Network Billing
An approved referral/authorization from VA supports a specific plan of care as it relates to a specified number of visits and/or services related to a Standardized Episode of Care (SEOC), as long as the services are provided by a CCN provider. Providers should always include the original VA referral number from the approved referral/authorization when billing TriWest. If out-of-network providers do not know the original referral number, they should contact the prescribing provider to acquire it.

Out-of-network providers must submit health care claims to TriWest by billing WPS Military and Veterans Health (WPS MVH), TriWest’s claims processor. Medical documentation related to care should be submitted to VA through the HealthShare Referral Manager (HSRM) online portal. Out-of-network providers are never allowed to balance bill a Veteran. The scope of care provided to a Veteran by an out-of-network provider must be included on an approved CCN referral/authorization.

Important Reminders
CCN network providers are reminded that:

  • All appointments for health care services are to be honored for authorized services.
  • Veteran appointments canceled by a network provider must be rescheduled in accordance with medical necessity of the Veteran and with VA guidance provided during implementation.

For more information, refer to these CCN Quick Reference Guides and the CCN Provider Handbook:

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VA Transition Winding Down for CCN Regions 1, 2 and 3

The Department of Veterans Affairs (VA) is near the end of its transition of the Patient-Centered Community Care (PC3) program to the Community Care Network (CCN) in Regions 1, 2 and 3 to Optum Public Sector Solutions, Inc. The transition period will conclude by the end of August 2020.

As a result, Optum is taking over the responsibilities for Regions 1, 2 and 3 and should be contacted for all concerns in those regions. TriWest Healthcare Alliance (TriWest) will still be here to assist with PC3 claims or authorization questions for any authorizations generated by TriWest. Additionally, the TriWest transition webpage will be removed by the end of August.

Urgent Care/Retail Location Benefit

The Urgent Care/Retail Location benefit responsibilities are scheduled to be fully transitioned to Optum in CCN Regions 2 and 3 on September 1, 2020. This encompasses both urgent care and urgent pharmacy prescription fills. Optum took over urgent care benefit responsibilities in Region 1 on March 18, 2020. TriWest will maintain the urgent care network in CCN Region 4.

More 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.

Thank You!

TriWest thanks you for supporting the important mission to care for our nation’s Veterans. We value your partnership.

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Remember: VA Medical Orders Included in Consults

TriWest has received feedback from VA Medical Centers (VAMC) that some network providers are not scheduling radiology appointments with Veterans because they believe the VA medical orders aren’t provided with the approved referral/authorization.

Please note that the medical orders are already included in the electronically signed consult. Therefore, it is not necessary to delay scheduling appointments with Veterans or to contact your VAMC for medical orders.

According to the VHA Handbook 1907.01, “paper documentation shall be authenticated prior to document imaging (scanning). An electronic signature is considered authenticated and does not need to be handwritten.”

For more information, please refer to VHA Handbook 1907.01 on VA’s website.

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Where to Find Pre-Appointment Medical History, Documentation

The Department of Veterans Affairs (VA) recommends that community providers review a Veteran’s medical history and documentation prior to each appointment. But are you and your provider team confused about where to find the Veteran’s medical history and documentation after the appointing and approved referral/authorization occurs?

Depending on how your office received the approved referral/authorization, the Veteran’s medical history may be sent by fax, secure email, or by mail within the authorization package. If the medical history has not been included, or you believe there may be missing pieces of information important to Veteran care, please access the VA HealthShare Referral Manager (HSRM) system for additional materials. HSRM facilitates information exchange between the VA Medical Center (VAMC) and community providers – including images, care history, and care status.

HSRM is a secure, web-based system VA uses to generate and submit referrals and authorizations to community providers. HSRM allows community providers and VA to better manage community care for Veterans. This link provides instructions on the steps to take to access HSRM.

If specific documentation such as path reports or imaging results are needed but aren’t available via HSRM, contact the point of contact on the approved referral/authorization or call the community care office at the referring VAMC to obtain the necessary information. It is also recommended that you verify you’ve received all medical documentation when the initial referral is accepted.

Finally, please make every effort to not cancel or postpone a Veteran’s appointment, as this impacts the continuity of care and causes additional challenges for the Veteran. For more information on how to access medical documentation prior to a Veteran appointment, visit the VA Community Care website or contact the referring VAMC.

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Provider Handbook Updates

In September 2020, the following information will be added to the Provider Handbooks:

  • CCN Handbook (pages yet to be determined): A recent contract modification with the Department of Veterans Affairs (VA) now allows TriWest Healthcare Alliance to reimburse certain out-of-network providers under the VA’s Community Care Network (CCN) for services provided under a CCN-approved referral.
  • PC3 Handbook (pages yet to be determined): The Department of Veterans Affairs (VA) Patient-Centered Community Care (PC3) program and approved authorizations under this program will officially end on March 31, 2021.

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Updated: 8/18/2020 11:42:01 AM