COVID-19 Response from TriWest Healthcare Alliance
In the wake of the COVID-19 (Coronavirus) pandemic, TriWest Healthcare Alliance continues to monitor the situation in cooperation with the Department of Veterans Affairs (VA) and its effect on the Patient-Centered Community Care (PC3) program. TriWest will use this web page to update providers on the latest information regarding the pandemic.
During the COVID-19 pandemic many of us have encountered challenges to our day-to-day lives. One thing that has remained steadfast is the ability for Veterans to have their immediate health care needs met by our exemplary network of community-based providers.
We are grateful to the work you do in support of both the Department of Veterans Affairs (VA) and our nation’s Veterans. We are proud to have you as part of our care network.
Thank you for being on the frontlines to care for our Veterans, and all those in the community, particularly during the COVID-19 pandemic.
Based on new COVID-19 guidance from the Department of Veterans Affairs (VA), TriWest is extending Patient-Centered Community Care (PC3) referrals previously set to expire March 1, 2020 – July 31, 2020, to a new expiration of Sept. 30, 2020. This means affected providers will NOT have to submit a Request for Services (RFS) to extend these authorizations for their Veteran patients if these extensions meet the Veteran’s needs without requiring more visits than authorized in the initial standardized episode of care (SEOC).
The following guidelines apply:
- Episodes of care cannot exceed 365 days in total with any extension.
- Inpatient, Emergent, Urgent and Home Health referrals are excluded.
TriWest will automatically update authorizations with the new end date of Sept. 30, 2020. These extensions to authorizations will be completed over the coming month and will be viewable by logging onto the secure portal at www.triwest.com/provider.There is no further action required by providers.
VA originally planned for a 60-day extension to authorization letters that ended between March 1, 2020 and July 31, 2020. However, this new update replaces the 60-day extension with a new end-date of Sept. 30, 2020.
Due to COVID-19, this extension will give community providers more time to offer needed services to Veteran patients.
Q: What resources is VA making available for Veterans during the pandemic?
- If a veteran has flu-like symptoms such as fever, cough, shortness of breath, please direct the Veteran to call their local VA medical center or MyVA311 (844-698-2311, option 3) before sending a Veteran to their local VA Medical Center (VAMC) or clinic.
- In addition to calling first, Veterans may contact their VA health care team to learn about VA’s telephone and video care options, as well as My HealtheVet Secure Messaging.
Q: Will VA cover the cost of COVID-19 testing?
- The current test available in the United States is the one provided by the CDC and some state public health departments at no charge. Any new COVID-19 tests that meet the required standards will be covered in accordance with CDC guidelines.
- If the Veteran has flu-like symptoms such as fever, cough, shortness of breath, or otherwise screens suspected positive for coronavirus, please follow local instructions for testing. DO NOT send a Veteran to VA directly. If there are any questions, please direct the Veteran to call their local VAMC or MyVA311 (844-698-2311, option 3) before sending them to the local VAMC or clinic.
Q: How should COVID-19 testing be billed?
- Once available for community testing, TriWest will pay for HCPCS code (U0001) and code (U0002) to cover the CDC 2019 Novel Coronavirus Real Time RT-PCR Diagnostic Test. These codes can be billed as ancillary services and will NOT require a Request for Service (RFS).
- If a Veteran contacts you and has flu-like symptoms, such as fever, cough, or shortness of breath, please advise him/her to call their local VAMC or MyVA311 (844-698-2311, option 3) if you cannot meet their needs through telehealth or an office screening. It is important to encourage Veterans with COVID-19 symptoms to call before visiting a provider office or going to their local VAMC or clinic.
Q: Will VA Cover the cost of COVID-19 care?
- Right now there is no specific treatment or vaccine for COVID-19, but VA will cover medically indicated symptom treatment.
- VA will cover authorized provider visits in the same way that other provider visits are covered through the Community Care program or other reimbursement authorities.
- Urgent care visits through the VA-contracted network will be covered based on Veteran eligibility.
- VA will cover emergency department visits, associated with inpatient admissions, and urgent care visits the same way that other acute needs are covered.
- TriWest providers should continue to submit claims directly to WPS MVH. Emergency room and/or inpatient care providers must call their local VAMC within 72 hours of care being processed to get an approved referral so they can be paid.
- For providers that are not contracted with TriWest, emergency care is covered but with specific eligibility per Veteran (i.e., enrolled in VA, seen in a VA or through VA community care in last 24 months, no VA emergency services are reasonably available, care is emergently needed). Suspected Coronavirus or similar infection symptoms will be presumptively considered emergent care, but other eligibility criteria does not need to be met in order for payment to be made by VA.
- For coding purposes, please follow CMS guidance found at https://www.cms.gov/About-CMS/Agency-Information/Emergency/EPRO/Current-Emergencies/Current-Emergencies-page
Q: What are VA facilities doing to contain potential infections?
- All VA medical facilities are in the initial stages of implementing screening measures for signs of respiratory illness and exposure to COVID-19. Via telehealth services, VHA will provide a first line of defense using virtual screening for symptoms or potential exposure. Standardized screening questions are in place for all administrative call centers and Clinical Contact Centers (CCC). Onsite at medical facilities, VHA is instituting a screening at all points of entry and following escalation pathways for positive screening. Facilities will use standardized screening questions at appointment check in and during initial clinical screening. In addition, facilities will use a two tiered system with an “active” COVID-19 zone and a “passive” zone for standard care unrelated to COVID-19.
Q: How will COVID-19 affect claims payment? How can providers receive payment faster?
- COVID-19 is impacting business processes across the world including TriWest and our claims processing partner WPS MVH. While on-site resources have been reduced to limit the spread of COVID-19, our teams are dedicated to reducing the impact on processing claims for our community providers. Some of that impact that we are trying to mitigate includes potential processing and payment delays for non-electronic claim submissions.
If you have not already enrolled in the option to submit your claims electronically, you are encouraged to do so now by visiting https://edi.wpsic.com/edir/home. Filing electronically will help speed up your claims processing. Providers must know the Trading Partner ID for their clearinghouse or billing service in order to enroll.
Q: Are providers authorized to use telehealth to treat patients?
- TriWest has determined at this time that under the Patient-Centered Community Care (PC3) program, providers who wish to utilize virtual or phone visits to treat patients and provide continued care while staying in compliance with CDC guidelines may do so, as long as the provider has an authorization on file first. VA has provided a waiver for all specialties under PC3 where virtual visits for the initial and subsequent appointments are now allowed in light of the ongoing pandemic.
Q: Which Place of Service should be used for billing telehealth visits? Which modifiers are appropriate?
- When billing professional claims for non-traditional telehealth services with dates of services on or after March 1, 2020, and for the duration of the Public Health Emergency (PHE), bill with the Place of Service equal to what it would have been in the absence of a PHE, along with a modifier 95, indicating that the service rendered was actually performed via telehealth.
Q: Which telehealth services require a prior authorization?
- All services require a prior authorization from TriWest to prevent claims denials.
Q: Which CPT codes are covered by telehealth?
- The Standardized Episode of Care (SEOC) authorization letter for primary care includes CPT codes to cover virtual treatment.
Q: What rules govern telehealth?
- Telehealth must be conducted consistent with Medicare guidelines.
- Providers must be aware of state and federal laws governing their ability to perform telehealth services.
Q: How will claims be paid and what documentation is required?
- Medical documentation must be submitted to the Veteran’s appointing VAMC, and claims must be submitted to WPS MVH, TriWest’s claims processor.
- Claims should be submitted within 30 days after services have been rendered. Providers will collect no copays, cost-shares, or deductibles.
- Providers will be paid for all authorized care according to their contract.
- According to 38 C.F.R. 17.55 and 38 C.F.R. 17.56, payments made by VA to a non-VA facility or provider shall be considered payment in full. Providers may not impose additional charges to TriWest or the Veteran for services that have been paid by VA.
Q: Is Acupuncture via telehealth covered?
- No, all covered codes indicate being billed involve actual insertion of a needle. Discussions over the phone are not covered. Herbal consultations, and consultations to discuss health are not covered by health insurance.
Q: Can providers bill telehealth services on the UB-04 form for PT/OT/SLP?
- Yes. Per CMS guidelines, there are not changes in the UB04 billing practice.
Q: Are chiropractic services covered under telehealth?
- Chiropractic services would be covered comparably to PT for telehealth in that coverage would be extended for some office visits and codes comparable to monitoring exercise (CPT 97110). CMS has provided information on appropriate telehealth coding. CMS has provided guidance to allow face-to-face levels of reimbursement for telehealth, therefore the face-to-face place of service would be used, as example 11, and modifier 95, to show it was done through telehealth.
Q: Is Physical Therapy covered under telehealth?
- Telehealth for Physical Therapy is in fact covered. All appropriate codes and modifiers will be required, in addition to modifier 95, showing care was rendered through telehealth. In terms of consents, authorization is still required.
Behavioral Telehealth Resources
Q: What considerations are made for appointing Behavioral Telehealth?
- When appointing for Behavioral Telehealth, extra considerations should be made. Below are questions TriWest asks Veterans to determine Behavioral Telehealth capabilities and comfort level:
- When would you prefer to use Behavioral Telehealth appointing?
- Do you have a secure (i.e., password-protected) Internet connection?
- Do you have either a webcam with a mic on your computer or front-facing camera on your tablet/smartphone?
- Are you comfortable, able and willing to download a Behavioral Telehealth application and/or other Behavioral Telehealth information to your device?
- Do you have a room or location in your home that will allow you privacy for your Behavioral Telehealth session?
- If Veteran does not have a private location, they are then asked: Are you interested in a point-to-point location?
(A point-to-point location would involve the Veteran commuting to an originating site [usually a small clinic or health center] and attending their telehealth session there via high speed network with a distance telehealth provider.)
Q: What is required for Behavioral Telehealth claim submission?
- TriWest pays providers’ claims for the Behavioral Telehealth services if the Veteran agrees, the scope of services are appropriate for a Behavioral Telehealth visit, and the parties have the ability to have the services be performed as a Behavioral Telehealth service.
- The CPT codes on the SEOCs do not need to be updated for Behavioral Telehealth appointments. VA has directed TriWest to pay Behavioral Telehealth visits even though the CPT codes are not explicitly listed in the SEOC.
- Providers can bill using the Medicare telemedicine methodology and guidance.
Q: Which Place of Service Code should be used?
- The service will need to have the normal Place of Service code with modifier 95 to indicate that the delivery method was telehealth. To receive reimbursement for telehealth services offered between facilities, known as Point-to-Point services, a code of Q3014 must also be submitted. If offering telehealth services into the home, please refrain from using the Q3014 code.
Q: What happens if a Veteran opts for a face-to-face session?
- Should the Veteran become uncomfortable during the session and wish to return to community based face-to-face care, they are allowed to do so at any time.
- A new authorization will be required as this will be considered a new consult.
Q: Must notice be given to cancel and/or reschedule a Behavioral Telehealth appointment?
- The Veteran MUST cancel or reschedule the appointment 72 hours before the scheduled Behavioral Telehealth appointment. Failure to do so will result in a no-call, no-show and the Veteran may lose their ability to use Behavioral Telehealth if a pattern develops.
Q: What other guidelines apply to Behavioral Telehealth appointments?
- The Veteran MUST be dressed appropriately for the session.
- Inform the Veteran that this session is no different than that of a face-to-face appointment. Inappropriate clothing or lack thereof will result in termination of the session.
- All weapons must be secured during the session to avoid any cause for alarm.
- The Veteran MUST have a space to perform Behavioral Telehealth health that is private, safe, and secure. This is to protect the Veteran’s privacy.
In response to COVID-19 (Coronavirus) and its impact on the health care system, the Department of Veterans Affairs (VA) and TriWest agreed to a 60-day delay for the start of health care delivery under the new Community Care Network (CCN) contract in Region 4. The new start date for rollout is delayed until June 8, 2020. TriWest and VA intend to fully deploy CCN throughout all of Region 4 by Aug. 31 2020.
TriWest has determined at this time that under PC3, providers who wish to utilize virtual or phone visits to treat patients and provide continued care while staying in compliance with the Centers for Disease Control and Prevention (CDC) guidelines may do so, as long as the provider has an authorization on file first. VA has provided a waiver for all specialties under PC3 where virtual visits for the initial and subsequent appointments are now allowed in light of the ongoing pandemic.
Please follow the Telehealth guidelines in Telehealth Quick Reference Guide.
TriWest is using the following guidelines regarding billing for COVID-19 tests, as well as telehealth treatment, for Veterans:
- Once available for community testing, TriWest will pay for HCPCS code (U0001) and code (U0002) to cover the Centers for Disease Control and Prevention (CDC) 2019 Novel Coronavirus Real Time RT-PCR Diagnostic Test. These codes can be billed as ancillary services and will NOT require a Request for Service (RFS).
- If a Veteran contacts you and has flu-like symptoms, such as fever, cough, or shortness of breath, please advise him/her to call their local VA Medical Center (VAMC) or MyVA311 (844-698-2311) if you cannot meet their needs through telehealth or an office screening. It is important that we all encourage Veterans with COVID-19 symptoms to call before visiting their provider office or going to their local VAMC or clinic.
COVID-19 is impacting business processes across the world including TriWest and our claims processing partner WPS Military and Veteran Health (WPS MVH). While on-site resources have been reduced to limit the spread of COVID-19, our teams are dedicated to reducing the impact on processing claims for our community providers. Some of that impact that we are trying to mitigate includes potential processing and payment delays for non-electronic claim submissions.
If you have not already enrolled in the option to submit your claims electronically, you are encouraged to do so now by visiting WPS MVH. Filing electronically will help speed up your claims processing.
For more information regarding COVID-19 guidance for providers, review this new fact sheet from VA.
Provider Services: General
- Email: ProviderServices@TriWest.com
Behavioral Health Questions
- Email: BHHelp@TriWest.com
Credentialing/Contracting/Network Participation Issues and Questions
- Phone: 866-284-3743
Claims and Billing Issues and Questions
- Phone: 866-651-4977
Customer Service (Claims, Authorization questions/support, Provider Portal Registration)
- Phone: 855-722-2838
PLEASE VISIT THIS PAGE FOR CURRENT UPDATES! (Last updated May 21, 2020)