Did you know that EDI, which stands for electronic data interchange, is a secure way to submit claims that also helps providers get paid faster?
Even if a paper claim is filed, the data still must be input into an electronic format. The work involved could increase the chance of errors and cause delays.
To avoid errors and delays, sign up for electronic claims submission today. Follow these easy steps:
- Visit www.TriWest.com/ClaimsInformation.
- Find the "PGBA EDI Provider Trading Partner Agreement" form.
- Complete the form and submit it to PGBA.
Providers are required to use the proper format when submitting claims. The VA referral number must be included on all non-urgent care claims submissions. If it is not, the claim will be denied.
Follow a few easy steps to help ensure your claim is accurate and paid on time:
PGBA requires the 10-digit VA referral number to be included in Box 23. Avoid extra spaces, characters or words. A “clean” VA referral number looks like this: VA0012345679.
Insert the VA referral number in the following claims 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
Reminders for Accurate Claims Submissions
For every Veteran claim, submit the VA referral number AND one of the following:
- 10-digit Electronic Data Interchange Personal Identifier (EDIPI)
- 17-digit Veteran ICN as found on VA authorization letter
- 9-digit Social Security number (SSN)
- Last 4 digits for SSN with preceding 5 zeros (Example: 000001234)
Reminder for Ancillary Providers
Providers are required to share the VA referral/authorization number with ancillary providers servicing the Veteran as part of the authorized 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.
VA provides many opportunities for providers to train and expand their skillset. Through the VHA TRAIN portal, providers can access the TRAIN Learning Network, a comprehensive catalog of public health training opportunities. The learning programs found on VHA TRAIN support the professional development needs of public health and health care providers, with a focus on Veteran patient care.
VA is encouraging providers to register for two self-study courses to help protect Veterans:
- MISSION Act Section 131: Opioid Safety Initiative
- MISSION Act Section 133: Preventing Suicide Through Lethal Means Safety & Safety Planning
To register for these courses, click the link to the course and sign in to VHA Train. These courses offer flexibility and you can register and participate whenever it’s convenient for you.
Upcoming Live Webinar Training for CCN Overview
Interested in learning more about CCN? Enroll in a live webinar. The upcoming webinar includes 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 live webinar will take place on June 16 at 11 a.m., MDT.
- Similar webinars are planned for 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.
There are no updates planned for the CCN Provider Handbook.