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Provider Pulse – December 2021

Issue 1 | Issue 2

December 2021 | Issue 2

How to Order and Bill for Intrauterine Devices (IUD)

The Department of Veterans Affairs (VA) has recently added Intrauterine Devices (IUD) to the Community Care Network (CCN) Urgent/Emergent Formulary in Regions 4 and 5 for Veterans. In the context of a valid VA OB/GYN referral, providers may directly purchase IUDs and bill them to TriWest or providers can order IUDs through network specialty pharmacies. Once the IUD is received, the provider can then perform the implantation procedure and bill TriWest for the service.

The implantation device and the implantation procedure are billed separately. The device is billed to Pharmacy claims (Express Scripts) and the procedure is billed to medical claims (TriWest’s claims processor, PGBA).

The IUDs available through CCN Regions 4 and 5 include the following brands: Mirena, Liletta, Nexplanon, ParaGard, Skyla, and Kyleena.

For more information on the process to order and bill IUDs and to view a list of specialty pharmacies, please review the IUD Process Quick Reference Guide.

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Reminder: VA Coordinates In-Vitro Fertilization Care

In-vitro fertilization (IVF) care coordination recently transitioned from TriWest Healthcare Alliance (TriWest) to the local VA Medical Centers (VAMC).

Assisted Reproductive Technology (ART)/IVF services are available to a limited and specific group of Veterans and their legal spouses (consistent with applicable law and VA clinical guidelines) for whom the VA determines have a service-connected (condition that results in their inability to procreate without the use of fertility treatment. Veterans must meet VA eligibility requirements. VA determines which Veterans are eligible for ART/IVF services.

For eligible Veterans and spouses, their supervising VAMC will send an authorization for care to the network provider after VA has determined eligibility for ART/IVF services through the CCN.

VAMCs will refer Veterans to qualified CCN providers closer to a Veteran’s home. Once a provider agreement is established, VA will coordinate an authorization for care that includes all routine labs, medications and radiology that are required to deliver ART/IVF services. Medical records and documentation are required to be returned to the authorizing VAMC for every date of service.

How Can We Help You?

If you have additional questions or issues, please do not hesitate to reach out to our team here at TriWest. We are here to help connect you to the appropriate resources.

For more information regarding ART/IVF services, refer to the ART-IVF Welcome Packet.

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U.S. Territories in Pacific Shifting to CCN Region 4

Beginning in late January 2022, the U.S. territories in the Pacific, including Guam, American Samoa, and the Northern Mariana Islands will transition to VA’s CCN Region 4 territory of responsibility.

In addition, CCN Region 5 (Alaska) will be fully transitioned from Patient-Centered Community Care (PC3) to CCN in March 2022.

For more information about the transitions, please refer to our Provider Transition Information page.

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Get Your VA Claims Paid Faster, Without Returns

The accuracy of the VA CCN claims that you submit to TriWest directly impacts the timeliness of TriWest’s reimbursement to you. Here are two things that you can do to help expedite claims processing:

By submitting electronic and clean claims and establishing electronic funds transfer, you can help us turn around clean claims with payment to you within 30 days!

Here are some other claims resources to help you submit your claims to TriWest’s claims processor PGBA:

Thank you for all you do to care for our nation’s Veterans!

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Go Online and Save Time Checking Claim Status

We understand that you may be anxious about your claims being paid and don’t want to call TriWest to find out your claims status. But did you know that you can go online to Availity, TriWest’s one-stop shop for CCN information and training, to get real-time status updates and avoid any wait times or call transfers?

TriWest and Availity recently enhanced the online claims search experience to give you a more intuitive and robust workflow to check the claim status of your Veteran members. Claim Status allows you to check the status of a submitted claim and view remittances.

These newly implemented, time-saving 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

You can search claims by:

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

Take the following steps to use the Claim Status tool:

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

If you’re not signed up with Availity, register for a free account to use your single user ID and password to check your claims status and access all TriWest information, webinar sessions, quick reference guides, and the CCN Provider Handbook.

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Provider Handbook Updates

There are no updates planned for the CCN Provider Handbook or the PC3 Provider Handbook.

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December 2021 | Issue 1

How to Get Your VA Claims Paid Faster, Without Returns

The accuracy of the Department of Veterans Affairs (VA) Community Care Network (CCN) claims that you submit to TriWest Healthcare Alliance (TriWest) directly impacts the timeliness of TriWest’s reimbursement to you. Here are two things that you can do to help expedite claims processing:

Clean claims, submitted electronically, can help us turn around payment to you within 30 days!

Take a look at these additional resources:

Thank you for all you do to care for our nation’s Veterans!

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Save Time, Go Online to Check Claims Status

Need information about a claim status, but don’t want to spend time on the phone? Visit Availity to get real-time status updates.

Chat with TriWest Securely from Availity

Visit Availity and select the TriWest Payer Space. Choose Chat with TriWest to check claims status 24/7 or chat with a representative 8 a.m. – 6 p.m. in your time zone.

Check Multiple Claims and View Remittances

Visit Availity and select Claims & Payments on the top navigation, then select Claim Status.

Not Logged In to Availity? Use New Claim Status Tool on TriWest’s Site

Visit TriWest’s Claims Information page on www.TriWest.com and select the Claim Status Lookup Tool for a quick status check, one claim at a time.

Important Reminder: If you’re not signed up with Availity, register for a free account to use your single user ID and password to check your claims status and access all TriWest information, webinar sessions, quick reference guides, and the Provider Handbook at any time.

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PC3 Service Line Closed Except for Alaska, Pacific Providers

The existing Patient-Centered Community Care (PC3) network will transition over time to allow for CCN implementation to occur region-by-region in a phased approach.

As of Sept. 30, 2021, the service line of 855-PCCCVET (855-722-2838) has been closed for callers except for those from Alaska and the U.S. territories in the Pacific, including Guam, American Samoa, and the Northern Mariana Islands.

Please submit all Claims Reconsideration Requests to the Claims Written Correspondence address:

TriWest Claims
PO Box 42270
Phoenix. AZ 85080-2270

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VA Offers Training on Opioid Crisis December 16

VA is offering a new knowledge-based training course to address the fourth wave of the opioid overdose crisis. It will describe strategies and actions that community providers and health care teams can take to improve care for Veterans as well as mitigate the risk for overdose.

The course will be held on Thursday, Dec. 16, at 1 p.m. ET, and is intended for physicians, nurses, psychologists, pharmacists, physician assistants, and social workers. It is offered through VHA TRAIN, the VA’s training website. Use this link to access the course. To access an available course, you need to create an account.

Participants will receive one hour of accreditation through AAPA, ACCME, ACCME-NP, ACPE, ANCC, APA, ASWB, JA IPCE, NYSED-P, and NYSED SW.

For help, please contact the VHA TRAIN help desk by email at VHATRAIN@va.gov.

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Updated: 7/12/2022 9:54:27 AM