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Provider Pulse: July

Provider Pulse

July 2018

Welcome to July

Are you feeling the heat yet? We’re halfway through summer! It’s a light month of updates at TriWest, but we do have a few items to relay your way. The most important? We re-vamped our Billing Page with tons of new tools to help you get paid. Make sure to read about it below!

In This Edition:

Better Tools for Getting Paid

Do you like getting paid? So does TriWest, and getting your clean claims paid is one of the ways TriWest gets paid! We pay you and then we get reimbursed by the Department of Veterans Affairs (VA).

TriWest is an administrator for two VA community care programs: the Patient-Centered Community Care (PC3) and Veterans Choice Program (VCP). In this role, TriWest not only manages the network of community providers, we help with appointments, share medical documentation, educate providers and, through our claims processor WPS Military and Veterans Health (WPS MVH), we process claims.

To help ensure that community providers can find the resources they need to efficiently bill and get paid, TriWest has updated and refocused our Provider Billing Page at www.triwest.com/provider-billing.

Here are some of the tools you will find:

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NOW AVAILABLE: Update Your Contact Information on Availity!

Moved to a new office location? Switched your fax number? Wrong phone number got you down?

Do not fear; Availity is here! And using Availity at www.availity.com, you can now update your own demographic or contact information within TriWest’s records.

TriWest recently launched a new Payer Space on Availity, a multi-payer site where you can use a single user ID and password to manage all the health plans you participate in. Availity is compliant with all HIPAA regulations and there is no cost for providers to register or use any of the online tools.

The TriWest Payer Space on Availity hosts many of the resources currently available on TriWest’s existing Provider Portal–such as quick reference guides, the Provider Handbook, and webinar registration. Eventually, the TriWest Payer Space on Availity will become the new way to access TriWest’s current Provider Portal resources.

In the meantime, we recommend you register for both an account on Availity, as well as on www.triwest.com/provider.

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New Process for Requesting Routine DME

As of July 12, 2018, the process for requesting routine Durable Medical Equipment (DME) for Veterans is changing!

You will no longer send secondary authorization requests (SAR) to TriWest for routine DME. Instead, send a DME prescription directly to your local, authorizing VA Medical Center.

VA will then coordinate the routine DME directly with you and the Veteran. TriWest will no longer be involved in the process.

Urgent/Emergent DME Remains the Same

Despite the changes for routine DME requests, the process for urgent/emergent DME remains unchanged. You may still directly administer urgent/emergent DME and bill TriWest afterward.

For more information on the urgent/emergent DME process, or the changes to routine DME requests, review our "Durable Medical Equipment Quick Reference Guide."

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5 Simple Steps to Send a SAR

Chances are, if you’ve treated a Veteran at your office, you’ve heard of secondary authorization requests (SAR). But when do you need a SAR, and what’s the right process?

Many providers have grown confused by SARs under the VA community care programs. In reality, it’s a simple process that takes five, simple steps.

**Please note: if you’re an Alaska provider, the SAR process is different. Check out the Alaska SAR process by reviewing our Alaska Quick Reference Guide.

  1. Determine if You Need a SAR
    You will need to submit a SAR if:
    • A Veteran needs additional care from another provider or office with a different TIN (such as a specialist)
    • You’re transferring a Veteran to another facility
    • You need to coordinate additional care after a discharge
    • A Veteran needs a second opinion from another provider
    • A Veteran needs continued care outside the specified date range on the authorization letter
    • A Veteran needs more or different services than what was authorized by TriWest
    Visit TriWest’s SAR Decision Support Tool at www.triwest.com/provider-sar to help determine if you need a SAR.
  2. Download the SAR Form from TriWest’s Provider Portal
    Once you’ve determined you need to submit a SAR, access the SAR form from the TriWest Provider Portal at www.triwest.com/provider. Click on the “Find a Form” menu item.
  3. Fill out the SAR Form and Compile Documentation
    Complete the SAR form and compile all additional documentation. You will need to include:
    • Necessary notes/medical documentation
    • Discharge plans
    • Post-operative needs
    • Justification for the request for additional care
  4. Fax the SAR to TriWest
    After you’ve completed the SAR form and compiled all necessary documentation, fax everything to TriWest at 1-866-259-0311. This fax number is also listed on the SAR form. Behavioral health providers should fax their SARs to 1-866-284-3736.
  5. Check the Status on TriWest’s Provider Portal
    If necessary, TriWest will submit your SAR to the correct VA Medical Center after reviewing it for completeness. VA’s turnaround time is usually around 14 business days. You may check the status of your SAR by logging into your secure account on the TriWest Provider Portal at www.triwest.com/provider.

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