Provider Pulse

May 2020

VA Community Care Network (CCN) Starting in June for Region 4

In this edition of the Provider Pulse, we note that the Department of Veterans Affairs (VA) Community Care Network (CCN) begins at initial VA medical centers in Region 4 on June 8, 2020. Other topics include the recent extension of some authorizations under the Patient-Centered Community Care (PC3) program until the end of September, verifying Veterans’ eligibility for urgent care, the transition of the Provider Portal to Availity, following the VA National Formulary requirements, and subscribing to VA’s new provider e-newsletter. Read all about these topics, and more, below.

Rollout of VA Community Care Network (CCN) Begins

The Department of Veterans Affairs (VA) new Community Care Network (CCN) is beginning its rollout in Region 4 on June 8, 2020. CCN is VA’s next generation of community care for eligible Veterans that is replacing the Patient-Centered Community Care (PC3) program. TriWest Healthcare Alliance and VA intend to fully deploy CCN throughout all of CCN Region 4 by the end of August 2020.

To help you prepare for CCN’s launch, TriWest is offering a series of provider CCN training webinars. Please register for these CCN webinars if you haven’t already by taking the following steps:

1. Log in to your account on Availity at www.availity.com.
   (If you don’t have an account, register for one for free.)
2. Navigate to the TriWest Payer Space.
3. Click on the TriWest Learning Center.
4. Register for the full range of CCN webinars at times that work for you.

Other Pertinent CCN Region 4 Information

• 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 will shift to the TriWest Payer Space on Availity at www.availity.com
• Availity will become your one-stop shop to access CCN training, as well as applications, quick reference guides, the Provider Handbook, and news and announcements.
• Providers should ensure they are fully contracted with TriWest as part of the CCN network. Some providers may have received auto-amendments to their existing PC3 contracts that do not require a signature, while others need to sign an updated or new contract to continue seeing Veterans under CCN.
• For more information, please visit ccn.triwest.com.

Review our fact sheet for an overview of the 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 committed providers like you to enhance Veterans’ access to health care services in this country!

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PC3 Authorizations Extended through September

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.

More information regarding TriWest's general COVID-19 response can be found at http://www.triwest.com/covid-19-provider-resource.

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Verify Eligibility Before Treating Veterans in Urgent Care

Under the Department of Veterans Affairs (VA) community care contracts, urgent care and retail location providers that are part of the TriWest provider network may treat Veterans who self-present. However, network urgent care/retail location clinics need to verify eligibility before treating a Veteran by calling 833-4VETNOW (833-483-8669).

Note that you do NOT need an approved referral/authorization to treat eligible Veterans under VA’s urgent care program.

Click here for a helpful document you can print and have available for Veterans who visit your urgent care location.

An Emergency Room (ER) visit does not need an approved referral/authorization, but the ER facility must call the closest VA Medical Center (VAMC) within 72 hours of providing care to the Veteran.

Remember: Providers may not collect any co-pay, cost-share, or deductible from a Veteran as part of this benefit.

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TriWest Provider Portal Transitioning to Availity

In early June, the existing TriWest Provider portal at www.triwest.com/provider will get a new look to align with the launch of the Department of Veterans Affairs (VA) Community Care Network (CCN).

TriWest is migrating its existing PC3 provider materials – such as quick reference guides, the Provider Handbook, and webinar registration – to the new TriWest Payer Space on Availity, a multi-payer online platform. With this move, Availity now becomes TriWest’s new one-stop shop for all training and information on both the PC3 and CCN contracts.

Visit www.availity.com to register for both PC3 and CCN webinars, and to access all resource documents for both contracts.

TriWest Legacy Portal Still Available Temporarily

During this time of transition, the TriWest legacy Provider Portal will still be temporarily available. From the new landing page launching in June, providers will still be able to access the PC3 Provider Handbook and quick references guides and have access to the secure portal to check PC3 authorizations online.

Please remember that the TriWest legacy portal will eventually become inaccessible, and all resource documents for both PC3 and CCN will only be available on the TriWest Payer Space on Availity. The Availity website will then become the sole platform where you can access applications, resources, news and announcements.

We have created a special page that includes frequently asked questions, who to contact with questions, and other information to help you navigate the Availity-TriWest site.

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Reminder: Follow the VA National Formulary Requirements

As a reminder, you must follow the VA National Formulary requirements when prescribing routine medication. If a preferred medication is not on the VA drug formulary, you must contact the authorizing Veterans Affairs Medical Center (VAMC) and request a Formulary Review Request form, fill out the form and return it to the authorizing VAMC for approval or denial. This process can take up to 96 hours for review.

Providers prescribing urgent or emergent medication must adhere to VA’s Urgent/Emergent Formulary.

Don’t Provide Drug Samples to Veterans

Providing drug samples to Veterans could have adverse consequences. Samples often require other criteria for use, do not contain important instructions on the package, or may have interactions with other prescribed medications that are tracked through the VA pharmacy system and can cause further complications for Veterans receiving VAMC-approved medications.

If a Veteran has an immediate prescription need and cannot wait or travel to a VA pharmacy, VA requests that you follow these guidelines:

• Write the prescription for up to a 14-day supply without refills, which can be filled at any local pharmacy for an out-of-pocket cost.
• The Veteran should then request reimbursement of the medication’s cost from the VAMC.
• The provider may write a refill prescription if the medication is needed past the initial 14-day supply, to be fulfilled at a VA pharmacy.

If you believe providing a drug sample to a Veteran is absolutely necessary, please contact your referring VAMC for guidance first.

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Subscribe to VA’s eNewsletter for Providers

TriWest Healthcare Alliance would like you to have access to all information possible that may help you serve our country’s Veterans. Along these lines, the Department of Veterans Affairs (VA) has an e-newsletter called, “VHA Office of Community Care Provider Advisor.”

Note that you do NOT need an approved referral/authorization to treat eligible Veterans under VA’s urgent care program.

This monthly e-newsletter for community providers can serve as another excellent and reliable source to obtain useful information and updates on VA Community Care, such as news, policies, and program changes. Providers can subscribe to it by clicking this link and entering their email address.

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Provider Handbook Updates

There are no updates planned for the Provider Handbook in May 2020.

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