This is a notice to all providers that any claims filed under Patient-Centered Community Care (PC3) will no longer be processed after March 31, 2024.
TriWest Healthcare Alliance (TriWest) administers claims for the current Department of Veterans Affairs (VA) Community Care Network (CCN) in Regions 4 and 5. VA’s PC3 program concluded in Region 4 on March 31, 2021, and in Region 5 on March 31, 2022.
For Current PC3 Claims:
- Services that fall under a retroactive referral, including reconsideration requests, must be submitted by March 1, 2024, to be considered.
- All PC3 claims requests (adjustments, reconsiderations, recoupments, etc.) will be processed no later than March 31, 2024.
- Effective April 1, 2024, PC3 claims will no longer be adjusted, and TriWest will not be able to accept PC3 claims or related inquiries and requests in any format.
Timely Filing Requirements Reminders:
- All community care claims must be submitted within 180 calendar days from the date of service. Claims that do not meet timely filing requirements will be rejected/denied accordingly. For detailed information on timely filing requirements, please visit the CCN Provider Handbook Timely Filing Requirements information.
- Community care claims reconsideration requests must be submitted within 90 days from the original claim processed date. Effective January 1, 2024, reconsideration requests that are not submitted timely will be rejected upfront. Please reference the Claims Reconsideration Request Form and its instructions.
To align with the direction of VA CCN, Residential Treatment Centers (RTCs) will now be reimbursed using the VA Fee Schedule when rates are available.
As a reminder, RTCs should submit revenue codes which are specific to the services they provide, and also include the appropriate Healthcare Common Procedure Coding System (HCPCS) code.
To avoid denied or rejected claims, use the following guidelines when billing RTC services:
- Submit with Type of Bill (TOB) 861, with 100X revenue code, and the appropriate HCPCS code.
- Claims with TOB 861 and no 100X revenue code and/or HCPCS code will be denied.
- Do not submit RTC claims with TOB 111 and 100X revenue codes. This combination will be denied as a billing error.
- Hospital-based RTCs should bill revenue codes 01XX with TOB 111 or they should bill TOB 86X with 100X revenue codes and HCPCS code.
- Do not submit RTC claims with TOB 891 and 100X or 01XX revenue codes. This combination will continue to deny as a billing error.
As a result of the Veterans COMPACT Act of 2020, emergent suicide care for eligible Veterans in acute suicidal crisis at a VA or non-VA facility is a covered benefit. VA has updated COMPACT Act guidelines for acute suicidal crisis care for Veterans.
Veterans meeting certain criteria are eligible for urgent care or emergent care if in an acute suicidal crisis. A trained crisis responder or health care provider must also diagnose the Veteran's eligibility using given criteria, in order to enable this benefit.
Read more about the COMPACT Act and Veteran coverage for acute suicidal crisis in the CCN Urgent Care & Emergent Care Quick Reference Guide.
VA CCN is making a difference in the lives of Veterans. Each day, Veterans are receiving the health care services they earned and deserve. A chiropractor in the TriWest provider network shares why caring for Veterans is so important. Hear her personal story of service in a video about serving the unique needs of Veterans.
Are you interested in sharing your story of why you choose to care for Veterans under the Community Care Network? Contact Media@TriWest.com and let us know!
Under a VA CCN referral, any medically necessary immunizations included on the VA Urgent/Emergent Formulary will be covered. These immunizations are:
- RSV (Respiratory Syncytial Virus)
Please see the Adult Immunizations Pharmacy Process Quick Reference Guide for more information.
There are currently no changes planned for the CCN Provider Handbook.