Provider Pulse – August 2022
Q&A: VA CCN Electronic Claims Payment
By enrolling in Electronic Funds Transfer (EFT) you can get claims get paid faster.
Learn more about EFT and its benefits to you.
What is Electronic Funds Transfer (EFT)?
Electronic Funds Transfer (EFT) is a way for claims to get paid faster.
How does EFT work?
Rather than waiting for a check to arrive in the mail or going to the bank to deposit claims payments, EFT transmits money directly into your specified bank account.
How can I sign up?
Complete and submit the PGBA EFT/ERA Enrollment Package. Mail or fax the completed form as instructed. There are no fees to sign up.
When will I know when my request has been processed?
Once you have submitted your application, it takes approximately 30 days for EFT requests to be received and processed. After this period, it takes about seven days for EFT to begin.
How soon will I receive my VA CCN payments through EFT?
After the 7-day period, you will receive EFT payments for any VA CCN claims you submit in the next payment cycle.
Who can I contact with questions?
If you have questions while filling out the form or specifically about the EFT process, contact PGBA EFT customer service at 800-259-0264, option 3.
Other Helpful Resources
Visit the Claims Information page on TriWest.com for more information on EFT and submitting claims.
Payment Rates Updated for Toric Lens Implants
The Department of Veterans Affairs (VA) has provided direction to TriWest for reimbursing providers who perform Toric Lens Implantation Surgery for cataracts on a Veteran. This guidance comes after the Office of Community Care acknowledged its intent to include Toric Lens Implantation Surgery into the Calendar Year 2023 VA Fee Schedule with pricing that reflects Medicare guidance.
The effective date of this change is a date of service Oct. 1, 2020, and later. Until the CY2023 VA Fee Schedule is established, VA has directed that the maximum allowable fee that would be reimbursed will be the billed charges according to the provider’s contract. This ensures that the Veteran would not be liable for any out-of-pocket costs.
Claims with dates of service Oct. 1, 2020 or after that had previously denied will be reprocessed. Providers do not need to resubmit claims or contact TriWest for adjustment. Providers will be responsible for reimbursing any out-of-pocket costs, previously paid by Veterans.
If you have any questions, please call Claims Customer Service at 877-CCN-TRIW (226-8749).
REMINDER: Report Critical Findings to VA Within Two Business Days
VA requires providers to report critical findings within the earlier of two (2) business days of discovery or the timeframe required to provide any necessary follow-up treatment to the Veteran. Communication should be either verbal or written notice to the Veteran, referring provider, and VA.
If critical findings are discovered during urgent care/retail location treatment, providers must report them to the Veteran’s home VAMC within 24 hours by phone. Critical findings are defined as a test result, value or interpretation that, if left untreated, could be life-threatening or place the Veteran at serious risk.
NOW AVAILABLE: Web-Friendly Version of CCN Provider Handbook
TriWest Healthcare Alliance (TriWest) now has a web-friendly version of the Community Care Network (CCN) Provider Handbook. The online version is user friendly and easier to navigate. Rather than a single document, each topic of interest is divided into its own web page, making finding the information you need easier.
Access the online CCN Provider Handbook on Availity.com or on TriWest.com through the Provider Services drop-down menu.
Provider Handbook Updates
Page 14 of the CCN Provider Handbook has been updated to include details and guidance related to the live donor transplant care and support process.