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Provider Pulse – July 2023

VA Medical Policies Help Guide Care

The Department of Veterans Affairs (VA) has begun to publish medical policies for community care providers to help ensure recommended care meets VA clinical criteria. The policies help guide providers but are not intended to replace clinical judgment. These policies also do not affect provider reimbursement for care.

To view VA’s most current medical policies, visit the Community Care Medical Policy page on VA’s website. For more detailed information, take the Medical Policy webinar on VHA TRAIN.

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Reminder: Giving Sample Prescriptions to Veterans is Prohibited

There has been a recent uptick in complaints regarding Veterans receiving sample medications. As a reminder, it is prohibited under the Community Care Network (CCN) to give sample medication to Veterans.

Giving sample medications can be risky, as some samples given may not be on VA’s formulary, or VA may not be aware the Veteran was given samples and there may be overlap of the same drug class, ultimately leading to complications. There may also be a possibility that the Veteran is dependent on the drug that was provided as a sample and may be seeking the sample for cost reasons, or because he/she ran out of the medication.

For routine medication and non-urgent/non-emergent medicine guidelines, please refer to the General/Routine Prescriptions section of the CCN Provider Handbook.

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Avoid Denied Claims: Double-check the VA Referral Number

A VA referral number is required on all claim forms (except for urgent care), and could be the missing component to having your claim processed successfully. Avoid the number one reason for denied claims by including the VA referral number on every claim.

You can now easily look up the VA referral number for any claim online. Go to Availity and use the Chat with TriWest tool or visit www.triwest.com/claimsinformation for the look-up tool. These new self-service features were recently added to assist providers and billing teams with including the proper VA referral number on claims.

As a reminder, the VA referral number should be inserted in the following claim forms in specific locations:

  • CMS 1500: Box 23 Prior Authorization Number field
  • CMS UB04: Box 63 Treatment Authorization Codes field
  • EDI – two options
    • 2300 – REF (G1) Prior Authorization
    • 2300 – REF (9F) Referral Number

It is very important to exclude any extra characters, spaces, or words with the referral number, or the claim will deny.

For example, if the correct referral number is VA0001234567, referral numbers included in the following format would be denied:

  • Auth VA001234567
  • Auth # VA001234567
  • Ref VA001234567
  • Ref # VA001234567
  • VA 001234567
  • VA01234567

For more information, please refer to the Claims Submission Quick Reference Guide.

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VA Training Available for Providers

VA offers several continuing education opportunities at no cost to you!

These training sessions are conducted via VHA TRAIN, and can be completed at your own pace.

Topics include instruction in the importance of having conversations about suicide lethal means safety and firearms during safety planning in all types of clinical encounters and improving patient outcomes related to opioid prescribing in pain management. Below are training session specifics:

Preventing Suicide Through Lethal Means Safety and Safety Planning:

  • Accreditations offered: APA, ACCME, ACCME-NP, ANCC, APA, NBCC, ASWB, NYSED SW
  • Location: VHA TRAIN
  • ID # 1075258
  • Time: One (1) hour duration

Firearms & Suicide in Military-Connected Community - Five Things Medical Professionals Need to Know:

  • Location: PsychArmor
  • Time: 25 minutes of video content with 12 total lessons

Opioid Safety Initiative:

Time: One (1) hour duration

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Provider Handbook Updates

The CCN Handbook will be updated soon to include instructions for providers on how to use a new online tool for submitting a claims reconsideration.

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Updated: 9/19/2023 10:27:31 AM