Provider Pulse
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March 2021
Welcome to March
March brings us spring and new beginnings. This month, we highlight two new beginnings with PC3 ending in CCN Region 4 and a new CCN claims processor. Included in this issue:
Included in this issue:
PC3 Ending March 31 in CCN Region 4
The Department of Veterans Affairs (VA) Patient-Centered Community Care (PC3) ends on March 31, 2021, in Community Care Network (CCN) Region 4. Continuity of care will be a priority but will require that the provider is contracted under CCN. Best efforts will be made in situations where a Veteran must change providers.
Effective April 1, 2021, new authorizations for care must be under CCN. Please do not submit a Request for Service (RFS) to continue care under PC3. Only CCN contracted providers may send an RFS to VA to obtain a new approved referral/authorization under CCN if you have not already received an updated authorization.
VA requires all providers to be fully contracted, credentialed, and in-network with TriWest to participate in CCN and continue receiving referrals for Veterans. If you have not signed a CCN contract to continue to care for Veterans, please contact TriWest at 866-286-4174.
Additionally, if ongoing Veteran care has not yet been transitioned to CCN, please direct the Veteran to contact their local VA Medical Center to request an extension of care under CCN if ongoing care is needed.
TriWest will continue to pay PC3 claims on approved referrals for dates of service through the authorization expiration date or March 31, 2021, whichever comes first. Providers should submit PC3 claims within 30 days for timely reimbursement. Check your authorization for specific instructions on where to send claims.
If you need to check a PC3 claims reimbursement status, login to your Availity account or contact a TriWest representative via the Availity chat function.
PGBA Selected as TriWest’s New CCN Claims Processor
TriWest has selected PGBA to be its new vendor for processing and paying CCN claims.
The claims processing transition will begin soon.
PGBA represents over 40 years of continuous service in health care claims administration, operations management, and government contracting. PGBA has a long, successful history in government claims processing, supporting the Department of Defense’s TRICARE program and, more recently, VA.
Take Steps Now to Prepare to Work with PGBA
To prepare for the upcoming transition of claims processor, TriWest encourages you to begin the process of enrolling in electronic claims and funds transfer through PGBA at this time.
- Enroll in Electronic Funds Transfer (EFT) and/or Electronic Remittance Advice (ERA) with PGBA.
- Visit TriWest’s Payer Space on Availity. Go to the Resources tab for the PGBA EFT/ERA Enrollment Package.
- Questions? Contact TriWest Provider Services at providerservices@triwest.com or call TriWest’s toll-free CCN Contact Center at 877-CCN-TRIW (877-226-8749).
Check Your Authorization Letter for Instructions on Where to Send Claims
As always, and especially during this transition period, please refer to each authorization for specific instructions on where to submit a Veteran claim.
Please note there are no changes occurring to Delta Dental or Express Scripts (pharmacy) claims processing.
Free Training for BH Providers Treating Veterans
VA is offering free, online two-day training classes for licensed behavioral health providers who treat Veterans.
Assessment of PTSD and Suicide Risk is offered through a live video conference and includes didactic presentations and roleplay demonstrations with opportunities for participants to ask questions. Assessment tools will be provided.
A team of expert clinicians from VA’s PTSD and Suicide Risk Management Consultation Programs will provide the training with the Center for Deployment Psychology. Topics include:
- Military culture
- How to assess and diagnose PTSD
- Essential treatment recommendations
- How to identify and assess suicide risk
- Lethal means safety
- Safety planning
All sessions will be held from 10:00 a.m. - 6:30 p.m. ET:
- May 12-13 (Wednesday & Thursday)
- August 5-6 (Thursday & Friday)
Behavioral Health providers can apply online at https://deploymentpsych.org/TAPTSDSRMV.
Whether or not you attend one of these training sessions, VA’s consultation programs are available anytime to all providers who treat Veterans at the following locations:
- Suicide Risk Management Consultation Program www.mirecc.va.gov/visn19/consult
- National Center for PTSD www.ptsd.va.gov/consult
Catch It Early! Screen Veterans for Colorectal Cancer
March is National Colorectal Cancer Awareness Month, and a great reminder that treatment for colorectal cancer in its earliest stage can lead to a 90 percent survival rate after five years. However, according to NCQA/HEDIS, more than one-third of adults ages 50-75 do not get recommended screenings.
A quality measure regarding colorectal cancer screening is a focus area within VA’s High Performing Provider (HPP) designation.
- Colorectal screening assessing adults ages 50-75 with appropriate screening
- G0105 – G0121
TriWest processes data from claims, implements an algorithm, and submits each provider’s HPP designation to VA. HPP designations can fall into the following possible categories:
- Yes or No - indicates the provider meets or does not meet the CCN HPP designation based on the quality and cost-efficient care criteria.
- Unknown - a default value to indicate that a CCN provider’s HPP designation has not been submitted to Provider Profile Management System (PPMS).
Thank you for your attention to preventive screening that contributes to quality health care for Veterans.
Provider Handbook Updates
CCN Provider Handbook Updates
- On Page 12 under Urgent Care Process, the following language was added: The Veteran will be billed separately by VA for any applicable copayment. If a Veteran has general questions about copayments, direct them to https://www.va.gov/health-care/copay-rates.
- On Page 13 under Urgent Care Process, the following language was added: Are you proud to be a network provider caring for our nation’s Veterans? Show your community! Download a Proudly Caring for Veterans badge for your website or office today.
- On Page 15 under Durable Medical Equipment, a list of what is required for all DME and medical device prescriptions was added. Information on hearing aids, home oxygen and oral appliance therapy also was added.
- On Page 17 under Medical Records and Documentation Requirements, Referral Number was added to the list of what medical documentation to submit.
- On Page 24 under Ancillary Providers, Medical Records and Documents, the following language was added: Ancillary providers who are unable to return medical documentation to VA must send to the referring provider for proper care coordination. Please refer to VA’s Facility Contact Information for Care Coordination for assistance.
- On Page 28 under the Alaska Appendix to the TriWest Provider Contract Provisions section, new sections regarding Medication Process, Durable Medical Equipment (DME), Hearing Aids, Home Oxygen, Oral Appliance Therapy, and Medical Records and Documentation Requirements were added.
- On Page 29 under Ancillary Providers, Medical Records and Documents, the following language was added:
CCN Claims Guidelines for Kodiak, Alaska Providers
The Department of Veterans Affairs (VA) Community Care Network (CCN) launches in Kodiak, Alaska, on Thursday, April 1. CCN is phasing in for Alaska and only the Kodiak area will begin CCN health care delivery on April 1. There is no change in claims processing for any other area in Alaska at this time.
CCN in Kodiak, AK Claims Processor – PGBA
TriWest Payer ID for Claims Processed by PGBA – TWVACCN
Address to Submit Paper Claims to PGBA
TriWest VA CCN Claims PO Box 108851 Florence, SC 29502-8851
Contact Center for Questions
TriWest Claims Customer Service Representatives are available to assist with CCN claims questions. Direct questions to 877-CCN-TRIW (877-226-8749).
Instructions for EFT/ERA Set Up with PGBA
Providers should login to their Availity account for secure access to electronic funds transfer enrollment materials.
Go to: https://www.availity.com Login. Select the Resources tab. Search for “PGBA EFT/ERA Enrollment Package”.
- On Page 30 under the Alaska Appendix to the TriWest Provider Contract Provisions section, information on Alaska Tribal Health was added, as well as a Behavioral Health Care Services section.
PC3 Provider Handbook Updates
- On Page 4, specific dates on the transition of PC3 to CCN were added.
- On Page 5, a CCN regional map was added.
- On Page 12 under Urgent Care Process, the following language was added: The Veteran will be billed separately by VA for any applicable copayment. If a Veteran would like more information on copayments, please direct them to https://www.va.gov/health-care/copay-rates.