Provider Pulse: April

Provider Pulse

April 2020

CCN Region 4 Delayed for 60 Days

The 60-day delay of implementing the new Community Care Network (CCN) in Region 4 is reviewed in the April edition of Provider Pulse. Other topics include TriWest’s special web page on COVID-19, how enrolling in electronic claims speeds up your payments, and two changes to emergency care. Read all about these topics, and more, below.

In This Edition:

VA Community Care Network (CCN) Region 4 Delayed

Due to the COVID-19 (Coronavirus) pandemic, the Department of Veterans Affairs (VA) and TriWest agreed to a 60-day delay for the start of health care delivery under the new Community Care Network (CCN) contract in Region 4. CCN is VA’s next generation of community care for eligible Veterans that will eventually replace the VA Patient-Centered Community Care (PC3) program. As a result, the new start date for rollout is now June 8, 2020. TriWest and VA intend to fully deploy CCN throughout all of Region 4 by Aug. 31, 2020.

The one exception to this delay is that VAMCs in CCN Regions 1, 2 and 3 or Veterans temporarily residing in CCN Region 4 exercising the right to self-appoint with an approved referral may reach out to CCN Region 4 providers to request appointments before the formal go live date in CCN Region 4. We anticipate the volume will be relatively low.

Despite this pause, TriWest is continuing to train providers in CCN Region 4 to ensure they are ready for the formal launch of CCN. TriWest started a new provider training program in March offering several webinars. Providers should register for these CCN webinars as soon as possible by taking the following steps:

  1. Log in to your account on Availity at www.availity.com.
    (If you don’t have an account, register for one for free.)
  2. Navigate to the TriWest Payer Space.
  3. Click on the TriWest Learning Center.
  4. Register for the full range of CCN webinars at times that work for you.

Other Pertinent CCN Region 4 Information

  • Claims will continue to be sent to WPS Military and Veterans Health (WPS MVH) even if care is rendered for a Veteran from CCN Regions 1-3.
  • Information previously contained on the Provider portal at www.triwest.com will shift to the TriWest Payer Space on Availity at www.availity.com.
  • Availity will be your one-stop shop to access CCN trainings as well as applications, quick reference guides, the Provider Handbook, and news and announcements.
  • Most network providers will receive auto-amendments to their contracts to align with CCN requirements. This means providers will not need to sign any new documents.
  • For more information, please visit ccn.triwest.com.

Here is a fact sheet we have created to provide an overview of the program, a map of the CCN regions throughout the country, and a description of the key program differences, by topic.

We are excited for this opportunity to continue partnering with VA and providers like you to improve Veteran health care in this country!

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COVID-19 Response from TriWest Healthcare Alliance

In the wake of the COVID-19 (Coronavirus) pandemic, TriWest continues to monitor the situation in cooperation with the Department of Veterans Affairs (VA) and its effect on the Patient-Centered Community Care (PC3) program. TriWest created a special web page to update providers on the latest information regarding the pandemic. We encourage providers to check the COVID-19 web page regularly for updates.

Using Telehealth to Treat Veterans

TriWest has determined that, at this time under PC3, providers who wish to utilize virtual or phone visits – referred to as telehealth – to treat patients and provide continued care while staying in compliance with the Centers for Disease Control and Prevention (CDC) guidelines may do so, as long as the provider has an authorization on file first. VA has provided a waiver for all specialties under PC3 where virtual visits for the initial and subsequent appointments are permitted in light of the ongoing pandemic.

Please follow the telehealth guidelines in our Telehealth Quick Reference Guide.

TriWest and VA Delay CCN in Region 4

In response to COVID-19 and its impact on the health care system, VA and TriWest agreed to a 60-day delay for the start of health care delivery under the VA’s Community Care Network (CCN) in Region 4. The new start date for rollout is delayed until June 8, 2020. TriWest and VA intend to fully deploy CCN throughout all of Region 4 by Aug. 31, 2020.

COVID-19 Billing Guidelines for Community Testing

TriWest is using the following guidelines regarding billing for COVID-19 tests, as well as telehealth treatment, for Veterans:

  • Once available for community testing, TriWest will pay for HCPCS code (U0001) and code (U0002) to cover the Centers for Disease Control and Prevention (CDC) 2019 Novel Coronavirus Real Time RT-PCR Diagnostic Test. These codes can be billed as ancillary services and will NOT require a Request for Service (RFS).
  • If a Veteran contacts you and has flu-like symptoms, such as fever, cough, or shortness of breath, please advise him/her to call their local VA Medical Center (VAMC) or MyVA311 (844-698-2311) if you cannot meet their needs through telehealth or an office screening. It is important that we all encourage Veterans with COVID-19 symptoms to call before visiting their provider office or going to their local VAMC or clinic.

Electronic Claims Offers Speedier Claims Payments

TriWest and our claims processing partner WPS Military and Veteran Health (WPS MVH are dedicated to reducing the impact of COVID-19 on processing claims for our community providers. Some of that impact we are trying to mitigate includes potential processing and payment delays for non-electronic claim submissions.

Filing electronically will help speed up your claims processing. If you have not already enrolled in the option to submit your claims electronically, you are encouraged to do so now by visiting WPS MVH.

For more information regarding COVID-19 guidance for providers, review this new fact sheet from VA.

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Sign Your Contracts to Continue Caring for Veterans

Due to the COVID-19 (Coronavirus) pandemic, the partial rollout of the Department of Veterans Affairs (VA) Community Care Network (CCN) contract in Region 4 has been delayed until June 8, 2020. TriWest and VA intend to fully deploy CCN throughout all of Region 4 by the end of August.

TriWest is still responsible for completing our obligations under our PC3 contract with VA including paying claims for all episodes of care authorized by TriWest. However, PC3 will end and be replaced with CCN by Aug. 31. Please note: VA requires all participating providers to be fully contracted, credentialed, and in-network consistent with CCN requirements in order to care for Veterans.

As a result, providers will start to see CCN referrals increase and PC3 referrals decrease starting June 8. You may still receive both (PC3 and CCN) for a period of time within CCN Region 4. CCN should be fully implemented by the end of August 2020.

Therefore, it’s important that you sign or have an auto-amended CCN contract with TriWest to continue receiving referrals for Veteran patients.

To help you prepare for CCN, you should have received a notice about your contract status with TriWest. There are three types of contract status changes:

  • Auto-Amendment – Your current PC3 contract will automatically be updated to prepare for CCN. No action is needed on your part, and the amendment is effective 30 days following receipt unless you explicitly reject it.
  • Amendment by Signature – You must sign the CCN amendment and return it to TriWest.
  • New Contract – You previously were not a PC3 contracted provider (although you may have been certified) with TriWest, and you must sign a CCN contract and return it to TriWest to become a CCN contracted network provider.

Most providers will receive notifications via email, but some may receive their notifications in the mail through the U.S. Postal Service. Additionally, contracting in CCN Region 4 will be done in phases, not only based on geographic location, but also based on provider type (existing [PC3] contracted provider, certified provider, and new network).

Contract Status Notices that Do Not Require Signatures

If you received a notice in the mail or via email about your contract status with TriWest, but TriWest didn’t request a signature, you most likely received an auto-amendment. This means you have officially been added to TriWest’s CCN provider network, unless you contacted TriWest within 30 days of receiving the notice.

As a member of the TriWest CCN provider network, please know that you may start receiving appointments and authorizations under the new CCN program as early as June 8, 2020.

A Better Future!

TriWest is extremely excited about the opportunity to work together with you as our partner as we continue to serve the needs of Veterans in CCN Region 4. If you have further questions about the new CCN program and how it will work, please go to ccn.triwest.com or email TriWest at ccnprovider@triwest.com.

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Enroll in Electronic Claims for Faster Claims Payment

COVID-19 is impacting business processes across the world including TriWest Healthcare Alliance and our claims processing partner WPS Military and Veteran Health (WPS MVH). While on-site resources have been reduced to limit the spread of COVID-19, our teams are dedicated to reducing the impact on processing claims for our community providers. Some of that impact that we are trying to mitigate includes potential processing and payment delays for non-electronic claim submissions.

If you have not already enrolled in the option to submit your claims electronically, you are encouraged to do so now by visiting WPS MVH. Filing electronically will help speed up your claims processing.

WPS MVH partners with the nationally recognized Committee for Affordable Quality Healthcare (CAQH) EnrollHub® solution, and combines enrollment capabilities for electronic funds transfer (EFT) and electronic remittance advice (ERA). This means a single, secure online process enrolls providers for electronic transactions with multiple health plans. Not only is this faster, but it is at no charge to your practice.

An alternative for low-volume submitters is to use Availity’s Basic Clearinghouse option. This is also free and convenient for providers who are enrolled and using Availity. Visit www.availity.com now for easy claims submissions.

Next Steps for Claims via Availity:

  1. Get registered with Availity and set up for electronic transactions. This allows you to submit claims to any of your payers/plans who are partnered with Availity.
  2. To submit electronic claims to WPS MVH, you must also enroll with WPS EDI. Visit its enrollment site.
    1. Use Availity’s Trading Partner ID of 70000 when enrolling with WPS MVH.
    2. Be sure to enroll for EACH type of transaction and EACH region you practice in.
    3. If you are new to electronic claims, you can view TriWest’s Electronic Transactions Enrollment overview on Vimeo.
  3. When submitting claims via Availity, choose the Region you are billing from in the “Payer” dropdown field.

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Two Important Changes to ER Care

There are a few important updates concerning Emergency Room (ER) care. Please take note of these changes carefully to continue delivering seamless services to our nation’s Veterans.

Change One: Contact the Nearest VA Facility, Rather than the Authorizing VA Facility

Previously, if a Veteran self-presented to an ER, the ER was required to call the authorizing Veterans Affairs Medical Center (VAMC) within 72 hours after seeing a Veteran. This requirement has changed. Instead of calling the authorizing VAMC, the ER must inform the nearest VA facility within 72 hours of providing care to the Veteran. The ER should still note the name of the person they spoke to in the medical documentation.

Change Two: Bill TriWest, Not VA, for ER Care

Another crucial update is that providers should bill TriWest for all ER care rather than billing VA. In the past, providers billed VA directly for emergency services.

Here are a few other important points related to ER care for a quick refresh:

  • Emergency care should be provided to any Veteran who self-presents to an ER.
  • All ER care is coordinated directly through VA, not TriWest.
  • Be sure to notify VA within 72 hours of providing ER care or VA will not be able to issue TriWest an authorization to pay the ER claim.

During these uncertain times, we at TriWest appreciate your commitment and dedication in serving our nation’s heroes! We take immense pride in having you as a valuable member of our provider network.

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Provider Handbook Updates

There are no updates planned for the Provider Handbook in April 2020.

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Updated: 7/8/2020 4:57:31 PM