Welcome to June!
Summer is here! And the heat is on at TriWest. This month, the Department of Veterans Affairs’ (VA) new MISSION Act went into effect, generating sweeping changes across the Community Care programs. In fact, so much evolved that we launched a webinar about it. VA now offers a new urgent care/retail care benefit for Veterans, and so much more too. Keep reading to learn about all the enhancements to community care!
In This Edition:
- Sign Up for New Webinar on VA Program Changes!
- New VA Urgent Care Program Launched June 6
- Help Veterans Get Timely Access to Care They Deserve
- New VA Portal to Help Providers Care for Veterans
- Need a VAMC Phone Number? Use this Map!
- TOP FAQ: Wrong Provider on My Authorization, Now What?
- Provider Handbook Updates
Starting June 6, 2019, the new VA MISSION Act went into effect, which means several changes are happening across the VA Community Care programs.
To help you better understand all of these changes, TriWest Provider Education developed a new webinar. Register now for the “VA Program Changes” webinar on TriWest’s Payer Space at www.availity.com!
What is the MISSION Act?
The MISSION Act was passed by Congress and signed into law by the President. According to VA: “The MISSION Act strengthens VA’s ability to deliver trusted, easy to access, high quality care at VA facilities, virtually through telehealth, and in your community.”
Where Can You Learn More?
The best way to learn how the MISSION Act will affect you—as a VA community care provider—is to sign up for our new “VA Program Changes” webinar.
- Visit Availity at www.availity.com.
- Navigate to the TriWest Payer Space.
- Click on the “TriWest Learning Center” application.
- Register for the “VA Program Changes” webinar.
For Veterans who have questions about the MISSION Act, you can send them to: https://missionact.va.gov.
As part of implementing the VA MISSION Act of 2018, VA started offering urgent care services to Veterans on June 6, 2019.
The new urgent care/retail care benefit will provide Veterans with greater choice and access to timely, high-quality care. The benefit is considered open access, allowing Veterans to access urgent care within VA’s community care network and receive care without prior authorization from VA. Instead, urgent care/retail location staff will just confirm the Veteran’s eligibility before providing care.
This benefit only applies to urgent care providers, retail locations, and convenience care clinics that are part of TriWest’s provider network.
If you are an urgent care or retail location that is interested in joining TriWest’s network to serve Veterans, please visit https://joinournetwork.triwest.com.
Urgent care providers treat injuries and illnesses that require immediate attention but are not life-threatening, such as:
- Flu-like symptoms
- Strep throat
- Minor burns
- Ear and skin infections
Diagnostic services like X-Rays, medications with some limitations, diagnostic lab testing, and therapeutic vaccines are also covered. However, urgent care is not a replacement for a Veteran’s preventive health services or disease prevention and treatment goals. The benefit does not cover preventive or primary care services.
For More Information, Register for Training
If you’d like more information on VA’s new urgent care benefit, you can take the webinar training on this topic. It’s available on TriWest’s Payer Space on Availity at www.availity.com, under the TriWest Learning Center.
VA is committed to providing eligible Veterans with the care they need when and where they need it. Our job at TriWest is to make sure that America’s heroes get connected to health care in their community.
New access-to-care standards have been established for the VA Community Care programs. These standards address appointment availability and scheduling, wait time once the Veteran arrives at the office, and drive time standards.*
A recent contract modification stemming from the VA MISSION Act of 2018 has changed the expectations for when a Veteran is scheduled to be seen by a VA community care provider beginning June 6, 2019. This change simplifies the scheduling timelines and the drive time standards to just two categories:
- Primary Care and Behavioral Health
- Specialty Care
The drive time is based on the distance from the Veteran’s home address to the provider service location. Compliance with these standards is monitored and reported to VA on a regular basis and is used as a reflection of network adequacy.
Veteran Scheduled To Be Seen By Provider
- Primary Care and Behavioral Health – within 20 calendar days of TriWest receiving the referral from VA
- Specialty Care – within 28 calendar days of TriWest receiving the referral from VA
Office Wait Time
- 30 minutes from scheduled appointment time
Basic Drive Time Standards
- Primary Care and Behavioral Health – within 30 minutes’ commute time
- Specialty Care – within 60 minutes’ commute time
TriWest supports the VA by enhancing access to health care for Veterans. You can champion this goal by making every effort to schedule a Veteran’s appointment to ensure he/she is seen by you within these care standards.
*Appointments for VA beneficiaries are made in accordance with the timelines and access standards applicable under Section 104 of the VA MISSION Act of 2018, Public Law No: 115-182, and implementing regulations.
To support community-based care for Veterans, VA has created HealthShare Referral Manager (HSRM), VA’s new software solution that will transform the way VA community care providers partner with VA to serve Veterans.
This new system simplifies and streamlines the referral and authorization process and facilitates robust information exchange – including images – through one easy-to-use and secure work platform. HSRM means less time faxing and emailing to VA, less time on hold with VA, and shorter turn-around time for clinical utilization and care coordination processes.
By using HSRM, community care providers can expect shorter wait times when contacting the authorizing VA Medical Center (VAMC) regarding Veteran care. In addition, community care providers can access a holistic and accurate view of a Veteran’s care and care status.
HSRM helps the way community care providers partner with VA to serve Veterans by:
- Supporting VA’s standardized referrals with information on the standardized episode of care (SEOC) format and data from VA
- Facilitating Health Information Exchange (HIE) between community providers and VA via one unified platform
- Tracking health care delivery by monitoring and recording services provided
- Capturing and retaining details regarding unique patient requirements
- Giving community providers the flexibility to refer Veterans for other specialized care and submit a Request for Service (RFS)
- Generating reports to inform decision-making and track workflow
Getting Set Up with HSRM
Access to, and use of, the HSRM portal is rolling out across all Regions during 2019. Regions 1, 2 and 4 will be the first to transition to this new portal.
To access the HSRM portal, your practice must first be in VA’s provider directory. If you are new to the VA Community Care programs, TriWest must submit your practice information to VA.
Providers also must set up a personal account with ID.me. This allows for a secure, two-step verification process each time a user logs in.
If your practice cannot utilize the two-step verification process – which requires a phone or text message – please contact the authorizing VAMC for other options. This may include a fax or a secure encrypted email, such as ProtonMail.
VA will provide training demos every Tuesday from 1-2 p.m. ET to help community care providers learn more about HSRM. Please register in advance at VHA Train. Coming soon will be HSRM eLearning modules and a user guide. For more information about HSRM, visit the OCC Resources Page.
Now that VA has taken over the collection of medical documentation, you may need to find a VAMC phone or fax number more frequently.
You can use this interactive map from VA: https://www.va.gov/directory/guide/home.asp. The map lists contact information for 1,929 VA facilities across the country!
Where to Find Your VAMC for Medical Document Submission
VA requires providers to submit the initial appointment notes, end-of-episode-of-care records, and inpatient discharge summary to the Veteran’s authorizing VAMC. But where can you find that information?
On the first page of your authorization letter, you will find the name of the authorizing VAMC. Then, you should look to the VA’s clinical consult for the VAMC’s contact information.
However, if you cannot find the VAMC’s phone number, go ahead and use VA’s interactive map to look it up.
It’s just that simple!
You are proud that your medical office helps care for the Veterans in your community. But when you get the authorization letter from TriWest, you notice something:
The wrong provider is listed on your authorization form.
What Should You Do?
Here’s the good news: any provider who bills under your practice’s Tax I.D. Number (TIN) can see the Veteran patient. As long as you bill under the same TIN, it doesn’t matter if you, or another provider, is listed on the authorization.
If you need an updated copy of your authorization records, please reach out to the TriWest authorization department at 1-855-722-2838, option 3, then option 1. The department representatives will assist you!
This is a retroactive change announcement. The following change was made to the TriWest Provider Handbook in June 2019 to comply with VA MISSION Act of 2018 requirements:
- Pharmacy/Prescribing Guidelines were added on page 18 of the Provider Handbook to align with the new VA MISSION Act benefit standards. VA does not permit community providers to dispense pharmaceutical samples to Veterans.
- The Access to Care Standards were updated on page 10 of the Provider Handbook to align with the new VA MISSION Act, which went into effect June 6, 2019:
- Scheduled Veterans need to be seen by the provider within 20 calendar days of TriWest receiving the referral from VA for primary and behavioral health care, and within 28 calendar days of TriWest receiving the referral from VA for specialty care.
- Basic drive time standards were updated to within 30 minutes’ commute time for the Veteran for primary and behavioral health care, and within 60 minutes’ commute time for specialty care.