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Provider Pulse – April 2022

Important Reminder: Filing Clean Claims Helps Avoid Denials

To help improve claims payment accuracy, the VA referral/authorization number is required with all VA Community Care Network (CCN) claims submissions. All claims submitted without a VA referral/authorization number will be denied. The only exception is urgent care.

Providers are required to share the VA referral/authorization number with the ancillary provider included in a Veteran’s episode of care. The ancillary provider is also required to use this same VA referral/authorization number when submitting their claim for the specific episode of care.

Tips to Avoid VA CCN Claim Denials

  1. Submit claims to PGBA with the following:
    • VA referral/authorization number AND one of the following:
      • 10-digit Electronic Data Interchange Personal Identifier (EDIPI)
      • 17-digit Master Veteran Index (MVI) ICN
      • Social Security number (SSN)
      • Last 4 digits for SSN with preceding 5 zeros (i.e., 00000XXXX)
  2. Do NOT use any extra characters, spaces, or words with the referral/authorization number or the claim will be denied.
    • Correct Example: VA0012345
      • Accepted: There are no extra characters, spaces, or letters; there are the correct number of digits; and it matches the referral.
    • Incorrect: Auth VA0012345
      • Denied: There are extra letters with “Auth” preceding the number.
    • Incorrect: VA 0012345
      • Denied: There is an extra space between “VA” and the numbers.
    • Incorrect: Ref # VA0012345
      • Denied: There are extra letters and an extra character with “Ref #” preceding the number.

For more information regarding proper claims submission, please refer to the CCN Provider Handbook.

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File Claims Electronically for Faster Processing

Filing your claims electronically can increase both the accuracy and payment timing. Enroll today to start submitting electronic claims to help turn around payment to you within 30 days!

You can also check your claims online, chat securely with TriWest staff, check multiple claims, and view remittances. Online options make claims filing and status check easier than ever.

To enroll, just follow these easy steps:

  • Log in to Availity.com.
  • Navigate to the TriWest Payer Space.
  • Click the Resources tab.
  • Find the "PGBA EFT/ERA Enrollment Package."
  • Complete the forms and submit them to PGBA.

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VA Live Webinars Give Overview on CCN

VA is presenting a series of live webinars in which provider participants will receive an overview of CCN. These webinars include the background on community care and the corresponding VA regulations.

In-depth discussions will be held on topics such as referrals and authorizations, authorized and unauthorized emergency care, urgent care, claims, and more.

The next webinar will take place on May 19 at 10 a.m., MST. Similar webinars are planned for June, July, and August 2022.

To access available sessions, log in to VA’s training website VHA TRAIN. Check the VHA TRAIN website for more information and other upcoming sessions.

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Provider Handbook Updates

The following language regarding Oral Appliance Therapy was updated on Page 16:

Oral Appliance Therapy: TriWest shall provide the capability for Eligible Veterans to receive Oral Appliance Therapy (OAT) for obstructive sleep apnea. OAT is considered a medical treatment for a medical disorder. It is not dental care and Delta Dental is not involved in contracting, appointing, and/or paying for OAT. Diagnoses for OAT include, but are not limited to, sleep apnea and temporomandibular joint disorder (TMJ). No dental care is approved on this SEOC.

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Updated: 9/15/2022 11:13:22 PM