CCN is Marching Forward
This March edition of Provider Pulse consists of special articles offering insight on CCN training, what to expect with your CCN contract, access to an updated website for all things related to CCN, and who to contact with any questions. Read all about these topics, and more, below.
In This Edition:
The Department of Veterans Affairs (VA) is rolling out a new program for its community providers in Region 4 starting on April 7, 2020, and TriWest is training providers now to be ready for the change.
The VA Community Care Network (CCN) is VA’s next generation of community care for eligible Veterans that will eventually replace the VA Patient-Centered Community Care (PC3) program. CCN is VA’s direct link with community providers to ensure Veterans receive timely, high-quality care.
Get Trained Now
To ensure providers in Region 4 are ready for the April 7 launch of CCN, TriWest started a new provider training program this month offering several webinars.
Providers should register for these CCN webinars as soon as possible by taking the following steps:
- Log in to your account on Availity at www.availity.com. (If you don’t have an account, register for one for free.)
- Navigate to the TriWest Payer Space.
- Click on the TriWest Learning Center.
- Register for the full range of CCN webinars at times that work for you.
Other Pertinent CCN Region 4 Information
- CCN implementation will begin at a few VA Medical Centers (VAMCs) within Region 4 on April 7, 2020, and will roll out in a phased approach through mid-July.
- Claims will continue to be sent to WPS Military and Veterans Health (WPS MVH).
- Information previously contained on the Provider portal at www.triwest.com/provider will shift to the TriWest Payer Space on Availity.
- Availity will be your one-stop shop to access CCN trainings as well as applications, quick reference guides, the Provider Handbook, and news and announcements.
- Most network providers will receive auto-amendments to their contracts to align with CCN requirements. This means providers will not need to sign any new documents.
- For more information, please visit ccn.triwest.com.
Here is a fact sheet we have created to provide an overview of the CCN program, a map of the CCN regions throughout the country, and a description of the key program differences, by topic.
We are excited for this opportunity to continue partnering with VA and providers like you to improve Veteran health care in this country!
With CCN beginning to take flight in two locations in CCN Region 4 on April 7, you will need to know how the new CCN program works before the start of health care delivery in your community to ensure you can provide seamless care to your Veteran patients.
To help you better understand the CCN program, TriWest is launching a full training program via its Payer Space on Availity that walks you through the new CCN processes and procedures. The training covers such topics as appointing and approved referrals/authorizations, claims submission, referral requests, and other CCN processes and procedures.
The training methods TriWest will make available include:
- Webinars – live, interactive virtual classes where providers can ask questions in real time. Now available!
- MicroLearnings (coming in April) – short, bite-sized video snippets that cover various aspects of the CCN program, such as three ways to submit a claim.
- Learning Paths (coming in April) – comprised of several MicroLearnings by topic that when viewed consecutively, form a complete eSeminar. Think of MicroLearnings as individual songs and the Learning Path as the playlist.
Register for Training Now!
To register for the CCN webinars, please log in to your Availity account. If you don’t have an account, sign up for an account for free.
After logging into Availity:
- Navigate to the TriWest Payer Space
- Click on the TriWest Learning Center
- Register for the various CCN webinars at the times that work for you
The MicroLearning videos and Learning Paths will also be available on Availity after they launch in April.
In addition to the CCN training listed above, VA encourages all community providers to complete its VA MISSION Act Section 133 general overview course, Community Care Provider–A Perspective for Veteran Care.
VA requires all participating providers in CCN Region 4 to be fully contracted, credentialed and in-network. As a result, and to help you prepare for CCN, you will receive a notice about your contract status with TriWest.
There are three types of contract status changes you could receive:
- Auto-Amendment – this means your current contract will automatically be updated to prepare for CCN. No action by you is needed, and the amendment is effective 30 days following receipt unless you explicitly reject it.
- Amendment by Signature – this means you must sign the CCN amendment and return it to TriWest.
- New Contract – this means you previously weren’t a PC3 contracted provider (although you may have been certified) with TriWest and must sign a full contract and return it to TriWest to become a CCN contracted network provider.
Most providers will receive notifications via email, but some may receive their notifications in the mail through the U.S. Postal Service. Additionally, contracting in CCN Region 4 will be done in phases, not only based on geographic location, but also based on provider type (existing [PC3] contracted provider, certified provider, and new network).
Contract Status Notices that Do Not Require Signatures
If you received a notice in the mail or via email about your contract status with TriWest, but TriWest didn’t request a signature, you most likely received an auto-amendment. This means you have officially been added to TriWest’s CCN provider network, unless you contacted TriWest within 30 days of receiving the notice.
As a member of the TriWest CCN provider network, please know that you may start receiving appointments and authorizations under the new CCN program as early as April 7, 2020.
A Better Future!
TriWest is extremely excited about the opportunity to work together with you as our partners as we continue to serve the needs of our Veterans in CCN Region 4.
Here is an overview of the CCN program. If you have further questions about the new CCN program and how it will work, please go to ccn.triwest.com. You can also email TriWest at ccn.triwest.com, email@example.com, or call 877-226-8749.
Here are some resources regarding Availity:
- For an overview of the Availity multi-payer platform – www.availity.com/healthplans
- For more information on the TriWest transition to Availity – www.availity.com
- For Availity technical support – call 1-800-282-4548
- You can also open a support ticket via your Provider Engagement Portal Account.
TriWest now has some latitude in covering CPT codes rendered under a Standardized Episode of Care (SEOC) authorization.
Not all services need to match the exact CPT codes listed on the authorization, as long as the CPT codes are medically necessary and related to the episode of care outlined in the SEOC, and are either traditionally included under Medicare-covered services, or listed on the VA fee schedule.
This leeway will allow providers to deliver additional services associated with the specialty referral without submitting a Request for Service (RFS) to the VAMC to add specific CPT codes to an authorization. This latitude is warranted to avoid delays in care for Veterans and reduce the administrative burden for providers and VA staff of processing excessive numbers of RFS. Providers must ensure that the CPT codes are related to the initial SEOC otherwise an RFS should be submitted. Requests for extensions of care and referrals to other specialties not included in the SEOC still require an RFS. Primary providers and ancillary providers are also required to include the authorization number on claims and submit all test results and/or additional documentation to VA or the claim may deny.
As a reminder, VA sets contractual guidelines when reimbursing claims and pays primary for all authorized care, following Medicare policies and guidelines.
There are no updates planned for the Provider Handbook in March 2020.