Provider Pulse: February

Provider Pulse

February 2020

Love is in the Air

February is the month of love as we celebrate Valentine’s Day and at TriWest, we love serving our nation’s Veterans with your help. In this month’s Provider Pulse, we discuss the Department of Veterans Affairs (VA) upcoming CCN Program and how the Urgent Care benefit is transferring to Optum in Region 1. Read all about these topics, and more, below.

In This Edition:

Coming Soon: VA Community Care Network (CCN) Program

Preparation for the rollout of the Department of Veterans Affairs (VA) Community Care Network (CCN) contract for Region 4 is underway at TriWest Healthcare Alliance. CCN is VA’s next generation of community care for eligible Veterans that will eventually replace the VA Patient-Centered Community Care (PC3) program.

Partial CCN program implementation will begin in Region 4 at a few VA medical centers (VAMC) on April 7, 2020, and will roll out in a phased approach through mid-July. In addition, TriWest will begin transitioning out of the PC3 program over the coming months.

To ensure you can provide seamless care to your Veteran patients, you will need to know how the new CCN program works before the start of health care delivery under CCN. To help you better understand the CCN program, TriWest will launch a full training program via its Payer Space on Availity. The training will cover appointing and authorizations, claims submission, referral requests, and other CCN processes and procedures. The training methods include:

  • Webinars
  • MicroLearnings (bite-sized videos)
  • eSeminars

When the training is available, we will send a notice to all providers. At that time, you will log in to your Availity account at www.availity.com to take the training.

Pertinent CCN Region 4 information

  • 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.
  • Claims will continue to be sent to WPS Military and Veterans Health (WPS MVH).
  • Information previously contained on the Provider portal at www.triwest.com (Quick Reference Guides and the Provider Handbook) will shift to the TriWest Payer Space on Availity at www.availity.com.
  • Availity is now your one-stop shop where you can access the Learning and Development page for various CCN webinars, eSeminars, and MicroLearnings for your CCN training as well as applications, quick reference guides, the Provider Handbook, and news and announcements.

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Urgent Care Benefit Transitioning to Optum in CCN Region 1

As the Department of Veterans Affairs (VA) continues its shift from the Patient-Centered Community Care Program (PC3) to the Community Care Network (CCN) across the country, Optum Public Sector Solutions, Inc. is increasing its coverage responsibilities in CCN Region 1.

The Urgent Care/Retail Location benefit responsibilities will transition to Optum in CCN Region 1 only on March 2, 2020. There will be no 30-day overlap period with the Urgent Care/Retail Location benefit. This encompasses both urgent care and urgent pharmacy prescription fills.

During this shift, TriWest Healthcare Alliance will continue to manage its network throughout the entire nation to support Veteran and provider care coordination until CCN is fully implemented. TriWest will work with Optum, which is the CCN contractor for Region 1, to ensure a smooth transition for providers and Veterans.

More information regarding the Region 1 CCN network can be found at https://vacommunitycare.com, or you can contact Optum’s CCN Provider Services Department at 1-888-901-7407.

Visit the TriWest CCN transition page for more information regarding this transition period and CCN.

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Provider Handbook Updates

In the December 2019 Provider Pulse under the “Provider Handbook Updates” section, we wrote about a change in grace periods for authorization letters. We published that the Department of Veterans Affairs (VA) would only allow TriWest to extend authorization letters for seven days rather than 60 days. This guidance was incorrect.

Please be advised that the current grace period of 60 days will not change and the Provider Handbook has been corrected with the language that existed previously regarding this process. We apologize for any inconvenience you might have incurred.

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

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Updated: 7/8/2020 4:57:30 PM