Provider Pulse

August 2017

Welcome to August!

We hope you've enjoyed your summer; we know it's fast coming to a close this month! With the upcoming change in seasons, we have some changes, too. Most importantly, as of September this year, TriWest will stop accepting claims with a date-of-service before Jan. 1, 2016. Make sure to read about it below, and keep reading for other important tips, such as who to contact for help. Happy August!

IMPORTANT: Update to Claims Filing Deadlines

As of Sept. 1, 2017, TriWest will stop accepting any claims with a date-of-service before Jan. 1, 2016.

As you know, TriWest has always encouraged providers to submit claims within 30 days of rendering services. Although TriWest made some exceptions to that rule in the past, beginning Sept. 1, we will not be able to accept claims for dates of service prior to Jan. 1, 2016.

What does this mean for you?

TriWest sent a fax blast about this change to our provider network in July, ensuring you have the time to submit outstanding claims by Sept. 1, 2017.

If you have outstanding claims to submit or re-submit, please send them now via the submission process below. Any claims with a date-of-service before Jan. 1, 2016, that are submitted after Sept. 1 this year will be denied, and you may not bill the Veteran.

Moving forward, we encourage you to submit claims within 30 days of rendering services, and never send a claim after 120 days. Adhering to the recommended 30-day timeline will help increase your cash flow, as well.

Claims submission process

Below is a quick refresher for the two-step process for submitting claims to TriWest:

1. Upload Medical Documentation to TriWest Provider Portal
   • Register for a secure account on TriWest’s Provider Portal at www.triwest.com/provider and upload medical documentation directly to the system.
     • Documents up to 5 MB can be uploaded in PDF or TIF format
   • If unable to access the Provider Portal, fax medical documentation to TriWest at 1-866-259-0311.
2. Submit Claims to Wisconsin Physicians Service (WPS)
   TriWest uses WPS for all claims processing. After submitting medical documentation to TriWest, send claims either:
   • Electronically. Set up an EDI to submit electronic claims by calling WPS at 1-800-782-2680 and selecting Option 1.
   • Via mail. Mail paper claims to the following:
     WPS-VAPC3
     PO Box 7926
     Madison, WI 53707-7926

Back to Top ↑

Who Should You Contact for Help?

Want to join the TriWest network? Need help logging into your secure Provider Portal account? Searching for an update to that authorization?

Make sure you know who to call, so you get the answer you need in the shortest amount of time! Below is a list of individuals you should contact for help, depending on your issue:

Questions on Electronic Claims Submissions (EDI)

• Contact Wisconsin Physicians Service (WPS) at 1-800-782-2680
  • Press Option 1 if you need to enroll for EDI
  • Press Option 2 if you already have an EDI

Requests to Join the TriWest Network

To request a network contract with TriWest:

• Email ProviderServices@triwest.com
• Once TriWest receives your email, we will forward it to the correct network representative for your geographic area to coordinate a contract.

Questions on Authorizations, Claims, or Technical Problems with the Provider Portal

• Call TriWest at 1-855-722-2838, Press Option 3, then press:
  • Option 1 for authorization questions
  • Option 2 for technical Provider Portal assistance
  • Option 3 for claims questions

Status of Secondary Authorization Requests (SAR)

• Visit the TriWest Provider Portal at www.triwest.com/provider and log in to your secure account.
• Look up your SAR status by searching with your original authorization number.
• If the Provider Portal does not supply an update, call 1-855-722-2838, press Option 3, then Option 1.

Other Miscellaneous Questions on Processes, Procedures, or the Programs

• Call TriWest at 1-855-722-2838, press Option 3, then Option 4

Back to Top ↑

Don't Always Send Veterans to VA for Labs, X-Rays

If you need to send a Veteran for a routine lab or X-ray, did you know you don’t always have to send the Veteran back to the Department of Veterans Affairs (VA) Medical Center?

The only time you should return the Veteran to the VA Medical Center is if it’s more convenient for the Veteran and the needed services are available at the VA Medical Center.

When TriWest sends you an authorization through one of the VA community care programs, the authorization will include routine labs and X-rays. For surgeries, it will also include anesthesiology services.

This means you can send the Veteran to any ancillary provider you desire for such services (lab, X-ray clinic, anesthesiologist, etc.). You just need to include your authorization number on the order form for the labs, X-rays, or anesthesiology services. Then, tell the ancillary provider to include the authorization number on their claim when billing TriWest.

Why is This Important?

TriWest recently received communication from several VA Medical Centers that providers have inappropriately been sending Veterans to them for routine labs and X-rays.

To reiterate the process, once TriWest has issued an authorization that includes routine labs and X-rays, the VA Medical Center does not have to provide those services. That responsibility has been given to the community—to you.

If your office doesn’t offer lab, X-ray, or anesthesiology services, you can refer out to whichever ancillary provider you choose. Just remember:

• Always include the authorization number on your order form for the labs, X-rays, or anesthesiologist; and
• Ensure the ancillary provider will bill TriWest, not the Veteran, and include the authorization number on their claim.

You can find more information on the provider claims submission process by reviewing our Provider Claims Quick Reference Guide.

Thank you for your attention to this matter and for partnering with us to help care for our nation’s Veterans!

Back to Top ↑