Provider Pulse: June

Provider Pulse

June 2020

Welcome to June

The June edition of the Provider Pulse showcases the start of the Department of Veterans Affairs (VA) Community Care Network (CCN) in Region 4 at initial VA medical centers. Other topics include a delay in the urgent care transition to Optum in CCN Regions 2 and 3; a new emergency care notification process, a new CCN Provider Handbook is now available; outpatient claims submissions during the calendar year; and updates to the PC3 Provider Handbook. Read all about these topics, and more, below.

In This Edition:

VA’s Community Care Network (CCN) Launched in Region 4

The new Community Care Network (CCN) is the Department of Veterans Affairs’ (VA) next generation of community care for eligible Veterans and a replacement for the Patient-Centered Community Care (PC3) program. Health care delivery under CCN in Region 4 began on June 8, 2020 in Montana and Eastern Colorado.

TriWest Healthcare Alliance, the third party administrator for CCN Region 4, created a fact sheet to give you an overview of CCN, a map of the CCN regions throughout the country, and a description of the key differences between PC3 and CCN by topic.

In addition, TriWest is offering a series of provider CCN training webinar sessions to help you prepare for health care deliver through CCN. Please register for these CCN webinar sessions, if you haven’t already, by taking the following steps:

Other Pertinent CCN Region 4 Information

For more information, please visit ccn.triwest.com.

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Urgent Care Transition Delayed in CCN Regions 2 and 3

As VA continues its shift from PC3 to CCN across the country, Optum Public Sector Solutions, Inc. is increasing its network and claims responsibilities in CCN Regions 2 and 3.

The Urgent Care benefit responsibilities will transition to Optum in CCN Regions 2 and 3 no earlier than August 3, 2020. More details will be forthcoming. This encompasses both urgent care and urgent pharmacy prescription fills.

Visit the TriWest CCN transition page for more information regarding this transition period from PC3 to CCN.

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New Emergency Care Notification Process

Effective June 8, 2020, providers treating Veterans who self-present to an emergency department should notify the Department of Veterans Affairs (VA) within 72 hours of the start of the episode of care. Community hospitals and providers should use the following methods to notify VA through a new centralized location, the Community Care Centralized Call Center, which is staffed and operated by Office of Community Care (OCC):

Once notification is received and reviewed by VA using the eligibility criteria, treating community providers will receive authorization decision information and, if applicable, directions on how to submit claims.

The new process allows VA to assist the Veteran in coordinating necessary care or transfer, and helps ensure that the administrative and clinical requirements for VA to pay for the care are met. This process applies to providers participating in Patient-Centered Community Care (PC3) and the Community Care Network (CCN).

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New CCN Provider Handbook Now Available!

As VA began rolling out the new CCN in Region 4 on June 8, TriWest posted the new CCN Provider Handbook on its Payer Space on Availity, as well as on ccn.triwest.com.

The Handbook offers providers a detailed look at CCN including:

For more information, please visit ccn.triwest.com.

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NEW! Submit Outpatient Claims Separately for Each Calendar Year

TriWest will no longer accept outpatient claims that span calendar years. You will need to submit a separate claim for services within each calendar year. For example, you should submit one claim with 2019 services and another claim for 2020 services.

TriWest is now following Medicare guidelines on this requirement.

For more information, please refer to Section 70.8.1 (Splitting Claims for Processing) of the Medicare Claims Processing Manual.

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Provider Handbook Updates

Updates will be made to the PC3 Provider Handbook in July, adding a telehealth section that addresses videoconferencing and other technology platforms used for telehealth services. These services must meet the requirements of the Health Insurance Portability and Accountability Act (HIPAA) Privacy and Security Rules.

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