Provider Pulse – June 2023
NEW! Turn Your Valuable Time into Fast Pay with the EFT/ERA Availity Enrollment App
Spend more time caring for our nation’s Veterans and less on claims paperwork and waiting on snail mail to get paid. Sign up for the new Availity EFT/ERA online enrollment tool!
This easy online tool enables secure and efficient EFT/ERA enrollment, and ensures you will save time by receiving automated and direct pay.
Consider the benefits of enrolling in EFT/ERA:
- No enrollment fee.
- No more time-consuming paper checks.
- Receive payment in as little as 10 days.
- Safe and secure funds transfer to your bank account.
To sign up, or learn more about the app, visit Availity.com, select My Providers | Enrollment Center | Transaction Enrollment.
Home Infusion Claims Must be Billed on the Same Form
In February 2023, TriWest’s claims processor, PGBA, implemented a change to allow concurrently administered therapy services on home infusion claims.
Home infusion claims are now required to have the appropriate SH and SJ modifiers appended to the second and third per diem service provided on the same day.
Here are the descriptions of each modifier:
- SH: Second concurrently administered therapy
- SJ: Third or more concurrently administered therapy
It is no longer permitted to bill home infusion codes on separate claims. All codes must be billed on the same claim form, and append the SH and SJ modifiers indicating the 2nd and 3rd administered therapy.
In addition, all services must be billed on the same claim form when billing for multiple concurrent per diem services, otherwise the separate claim submission will be denied as a duplicate.
For more information see the National Home Infusion Association (NHIA) National Coding Standard for Home Infusion Claims.
Coming Soon: CMS Local Carrier Rates for Region 4 Claims
In an effort to better align with Centers for Medicare & Medicaid Services (CMS) reimbursement methodologies, beginning July 1, 2023, TriWest Healthcare Alliance (TriWest) will begin using Local Carrier Pricing to process Community Care Network (CCN) Region 4 claims that are priced at Medicare allowable rates.
When pricing is not established on the CMS Physician Fee Schedule, and a local Medicare Administrative Contractor (MAC), such as Noridian or Novitas, has an established Relative Value Units (RVU) and payment amount for the service, the local carrier rate will be used.
Codes that meet this criteria can be found in the CMS Physician Fee Schedule, under the Procedure Status Code column (C=Carriers/MACs priced code).
- If the procedure code has a status C, the allowable local carrier price will be used for reimbursement when available.
- Radiopharmaceutical codes that have a status X may also be reimbursed at the allowable local carrier price.
If the provider's local MAC prices a code, that price will be used when available. When there is no CMS Physician Fee or MAC reimbursement, the local VA Fee Schedule will be used. When there is no CMS or VA Fee Schedule reimbursement, the code will be priced at the appropriate contracted discount for provider’s billed charges.
If you have any questions, please contact TriWest’s CCN Contact Center: 877-226-8749.
You can also refer to CMS or the local MAC website for more information on reimbursement rates.
New Microsite Highlights Behavioral Health 'Inspiring Stories'
TriWest has launched a new 'Inspiring Stories' microsite on its Behavioral Health web page, sharing stories of healing and personal accounts, inspiration and resources for Veterans who have struggled with mental health challenges resulting from trauma and other life events.
The new 'Inspiring Stories' resource highlights personal accounts from those sharing experiences to help initiate conversations about mental health challenges and healing. The site includes insights from behavioral health providers who work with Veterans, leading to new understandings as they have partnered to pursue healing.
In addition to personal stories of Veterans, TriWest family members, and others who have struggled with mental health challenges, useful resources, contacts and information are also provided.
If you would like to participate in an interview and share your expertise and insights for publication on the 'Inspiring Stories' page, please contact the TriWest team at TWnews@TriWest.com.
No Cost Training Available for PTSD and Suicide Risk Assessment for Veterans
This year, The Department of Veterans Affairs’ (VA) PTSD Consultation Program is offering continuing education credits at no cost to you! These 2-day training sessions are conducted via Zoom in Assessment of PTSD and Suicide Risk for licensed mental health providers who treat Veterans.
Upcoming training dates:
- July 19-20, 10 a.m. to 6:30 p.m. EST
More info on the upcoming training sessions can be found at Training on Assessment of PTSD and Suicide Risk Management in Veterans.
Providers who complete both days will receive a credit for future continuing education.
There are more education resources available from the VA National Center for Post-Traumatic Stress Disorder (PTSD).
Reminder: VA Request for Services Requires Provider Signature
Please remember to fill out all required fields on all Request For Services (RFS) forms. A signature from the ordering provider in the provider signature box is required.
RFS forms signed by office staff will no longer be accepted. Any supporting documentation must also be included with the RFS form to support VA clinical review and care coordination.
In general, Veterans Affairs Medical Center staff will process a completed RFS within three business days, and the provider will then be notified of the approval/denial. If forms received are incomplete, or lack the proper documentation, they may be sent back to the appropriate offices for completion.
For more information on the RFS forms, view the Request For Services Quick Reference Guide.
Provider Handbook Updates