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Claims Information

Take a Look: Enhanced Claim Status Tool on Availity

TriWest and Availity have enhanced the provider claims search experience on Availity.com by updating the Claim Status functionality. The tool now gives you a more intuitive and robust workflow to check the claim status of your Veteran members.

Improvements include:

  • More ways to search and filter results
  • The ability to have simultaneous multiple and different search options
  • The ability to view multiple claims status simultaneously
  • The ability to export search results into a CSV Excel file
  • A more detailed “claims status detail view,” allowing providers to see the reason for a claims denial

Search claims by:

  • Member ID
  • Tax ID
  • Service date
  • Claim number

Login to your Availity account and click on the Claims & Payments option located on the top-left corner of the main screen. Under Claims & Payments, select the Claim Status option.

VA Referral/Authorization Number Required with Claims Submission

Effective Oct. 1, 2021, TriWest requires the VA referral/authorization number with all CCN and PC3 claims submissions. All claims submitted without a VA referral/authorization number will be denied. The only exception is urgent care.

Providers are required to share the VA referral/authorization number with the ancillary providers included in a Veteran’s episode of care. The ancillary provider is also required to use this same VA referral/authorization number when submitting their claim in for the specific episode of care. Read more about the proper format for referral numbers in a claim submission.

Claims Submission Details

Electronic Claims

All CCN claims process electronically, regardless of the method of submission. This is a program requirement and therefore, filing claims electronically is preferred and encouraged. Read this Claims Q&A for details on electronic funds transfer, electronic remittance advice and electronic data interchange through PGBA, TriWest’s claims processor.

Start the process now to establish electronic claims processing through PGBA. Go to Availity.com and login. Navigate to TriWest’s Payer Space. Select the Resources tab. Find “PGBA EFT/ERA Enrollment Package” and/or “PGBA EDI Provider Trading Partner Agreement” for instructions and guidelines.

Payer ID

TWVACCN

Address to Submit Paper Claims to PGBA

TriWest VA CCN Claims
PO Box 108851
Florence, SC 29502-8851

Top Tips for Faster Claims Processing

We’ve narrowed it down to the top 3 most common errors we see in claims processing. Send your billing team these tips!

Sign Up for a PGBA Claims Webinar to Learn More

Login to Availity.com. Go to TriWest’s Payer Space. Select the TriWest Learning Center. Click on Sessions. Register for the “PGBA Claims” webinar.

Questions?

You can contact TriWest Provider Services at providerservices@triwest.com or call TriWest’s toll-free CCN Contact Center at 877-CCN-TRIW (877-226-8749).

Updated: 11/9/2021 3:05:13 PM