Provider Pulse – February 2023
VA Processing PACT Act Benefits Claims Effective Jan. 1
Effective Jan. 1, 2023, the Department of Veterans Affairs (VA) began processing PACT Act benefit claims for all Veterans.
The PACT Act is a significant expansion of benefits for Veterans and their survivors who have been exposed to toxins. More than 959,000 Veterans have received VA’s new toxic exposure screenings as a result, with approximately 39% reporting an exposure concern.
For more information, visit VA’s press release on PACT Act benefit claims.
Make Sure Your Durable Medical Equipment Meets VA Requirements
Make sure your durable medical equipment (DME) meets requirements presented by the Department of Veterans Affairs (VA) for prosthetics, orthotics, and sensory aid fulfillment services.
VA is the primary resource for all routine DME for Veterans. For urgent and emergent care, providers may directly supply Veterans with DME, and TriWest will reimburse providers.
Examples of urgent and emergent DME include splints, crutches, canes, slings, and soft collars.
Here are some additional reminders:
- Under the Community Care Network (CCN), TriWest pays Centers for Medicare and Medicaid Services (CMS) pricing on all DME.
- DME is covered under CCN for urgent and emergent care only.
- All other routine DME is coordinated with VA and VA Medical Centers.
For more information, look through the DME quick reference guide.
Electronic Claims Pay You Faster with Less Errors
Improve your claim submission accuracy and payment timing with electronic submission and funds transfer. You can do this by enrolling in Electronic Funds Transfer (EFT)/Electronic Remittance Advice (ERA) and Electronic Data Interchange (EDI) through PGBA.
TriWest, on behalf of the Department of Veterans Affairs (VA), is the payer for in-network authorized claims associated with an approved referral/authorization filed under CCN.
Go to www.TriWest.com/ClaimsInformation for all the details.
Please note that any past Madison, Wisconsin addresses for VA claims in CCN Regions 4 or 5 are no longer valid.
Catch Glaucoma Early to Prevent Vision Loss
Glaucoma can often begin without symptoms, which is why approximately 50% of people who have glaucoma don’t know they have it until their vision is greatly impacted, according to the Center for Disease Control.
When glaucoma is caught early enough, vision can be preserved – making it important to become informed, learn about the risk factors, and recommend regular eye exams.
Read about glaucoma, the second leading cause of blindness worldwide, in this new Healthy Homefront® blog post.
Whole Health System Approach: A Guide to Long COVID-19
Do you have patients who have new or worsening symptoms after COVID-19? The Department of Veterans Affairs (VA) has developed the Whole Health System Approach to Long COVID Guide to equip health care providers with a patient-centered, holistic approach to Long COVID care. The guide makes recommendations for labs, tests and consults to consider, and includes helpful at-a-glance information and links for the most common symptoms and conditions, including:
- autonomic nervous system dysregulation
- cognitive impairment
- fatigue and activity intolerance
- mental health
"This guidebook packages up the best practices we've learned about treating Long COVID, and it will help health care providers across America improve the lives of Veterans and non-Veterans alike," said VA Secretary Denis McDonough.
Additionally, VA created a Fact Sheet and Symptom Checker as a companion document for Veterans. Written in plain language, it defines Long COVID, describes the symptoms, and provides space for Veterans to write down their own symptoms to communicate with their clinicians and care teams.
These are living documents and will be updated as VA and the world continues to learn about Long COVID. Both the Guide and the Fact Sheet are available to the public to view and download on VA’s COVID-19 page.
New Availity Claims Status Categories Now Visible
TriWest continues to use Availity as its one-stop-shop secure portal for all information and training for the Department of Veterans Affairs (VA) Community Care Network (CCN). Availity is a multi-payer tool where you can use a single user ID and password to coordinate TriWest and other participating payers online.
Additional features have been added to the multi-payer space in the claims status application to include the claim status code and a detailed results category. In addition, two new categories will be available soon.
Additional added features include:
- New member search option (by ICN)
- Occurrence Codes added to claim detail
- Admission Types added to claim detail
- Present on Admission Codes added to claim detail
- Primary Diagnosis Codes added to claim detail
- Condition Codes added to claim detail
- Value Codes added to claim detail
Coming soon: Two new categories and their respective information are as follows:
- Claim Status Code/Description
- Requirement: "Return" status includes "return reason description" in claim detail.
- Category: Detail Results
- Requirement: Add "primary status code" line, level and description.
TriWest and Availity continue to enhance the claims view and registration experience for providers while also offering access to real-time information.
Register for a free account to access all TriWest claims information, webinar sessions, training videos, quick reference guides, and more on Availity.com.
Winter Wellness Health Tips: Keeping Mental Health in Focus
Keep focused on your physical and mental wellness this winter with tips from Health Homefront.
Throughout the winter months, it can be challenging to keep up with health and wellness goals. The days are shorter and darker, cold and flu germs seem to be everywhere, and the weather can make it hard to get outside and stay active.
Read about making healthy choices and taking time to recharge, in this new Healthy Homefront® blog post.
Provider Handbook Updates
There are no updates planned for the CCN Provider Handbook.