Provider Pulse

September 2020

Welcome to September

Now that summer is behind us, we eagerly look forward to fall. One major initiative underway is TriWest’s decommissioning of the Patient-Centered Community Care (PC3)-specific portal on www.TriWest.com. Additionally, we’re reminding network providers to take the opioid safety training that the Department of Veterans Affairs (VA) requires and we’ve implemented a new procedure on claims timely filing. Read all about these items, and more, below.

In This Edition:

Changes Coming Soon: TriWest PC3 Provider Website

In conjunction with the launch of the Department of Veterans Affairs (VA) Community Care Network (CCN), TriWest Healthcare Alliance (TriWest) will soon disable the Patient-Centered Community Care (PC3)-specific provider portal on www.TriWest.com.

If you are not yet registered in Availity, make the transition now. The PC3 provider website will begin a phased decommission process starting in early September. When the decommission is complete, the provider login, password reset and new registration links will not be accessible, and providers will no longer have access to PC3 authorizations or claims information through this website.

Please note: Previously bookmarked links will work for now, but once the site is fully decommissioned, they will no longer function.

TriWest rolled out a new and improved provider webpage and partnered with Availity, a multi-payer online platform that provides a one-stop shop for all claims information, and other community care resources, including the Provider Handbooks, Quick Reference Guides, live webinar trainings, MicroLearning videos, news and announcements.

If you are not registered for the Availity Portal, please register now to maintain access to the most up-to-date resources and tools for working with TriWest.

To access CCN-approved referrals/authorizations, providers should use the VA HealthShare Referral Manager (HSRM) system. HSRM facilitates smooth care coordination and information exchange between the VA Medical Center (VAMC) and community providers.

For technical assistance with the Availity Portal, please call Availity at 800-282-4548. For all other TriWest questions, please email ProviderServices@TriWest.com.

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Reminder: Opioid Safety Training Now a Requirement for Network Providers

The Department of Veterans Affairs (VA) now requires each individual provider within a practice or group who has a DEA number, and who can prescribe controlled medications to Veterans in the community, to take opioid safety training. VA also strongly encourages providers to complete training regarding the military and Veteran culture.

The opioid safety and culture training were both developed by VA. Providers have 180 days, from the later of July 1, 2020 or the date of their CCN Network contract, to download and review the opioid safety handout by visiting https://train2serve.com.

What Will the Training Cover?

The required opioid safety training is part of the VA Opioid Safety Initiative, a comprehensive strategy to reduce reliance on opioid medication and improve effectiveness and safety for Veterans. To meet the requirement, providers will register online at https://train2serve.com and download a two-page fact sheet.

The recommended military culture training emphasizes the importance of knowing the influence of military culture in a health care setting to help improve treatment outcomes for Veterans. According to VA, Veterans seen by culturally informed providers reported they were more satisfied with their visit, therefore more comfortable seeking and sharing information about their health care.

What Happens if Providers Don’t Take the Training?

Each individual TriWest provider with a DEA number must register to download and review the opioid safety handout. Providers who do not take the VA-mandated opioid training within the designated timeframe will stop receiving new Veteran referrals until they complete the training.

Next Steps – Take the Training!

To register and download VA’s opioid safety requirements:

  1. Visit https://train2serve.com.
  2. Select “Register Now”.
  3. Complete the registration process.
  4. Download the Opioid Safety Initiative information.

TriWest thanks its network providers for supporting the important mission to care for our nation’s Veterans.

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New Procedure Regarding Timely Filing

Starting Oct. 1, 2020, providers who initially submitted a claim to the wrong Department of Veterans Affairs (VA) payer (e.g., VA itself or Optum Public Sector Solutions, Inc., instead of TriWest) will now have more leeway with VA’s 180-day timely filing limit.

Follow these instructions to successfully correct your claim submission:

  1. Retain a copy of the remittance advice from the original submission to the wrong entity. This serves as documentation of timely filing and should be retained to ensure that the original submission date can be confirmed in the event of an audit.
  2. If submitting a Paper Claim: Print out and complete the Provider Timely Filing Form on TriWest’s Payer Space on Availity, and submit the Provider Timely Filing Form with your paper claim to WPS MVH.
  3. If submitting an Electronic Claim via EDI: Use an indicator “9”on the 837 in the data element field CLM20 to indicate resubmission for timely filing. The “9” indicator definition is for an Original Claim rejected or denied for reason unrelated to the billing limitation rules. Claims with the “9” resubmission indicator will bypass automatic timely filing denials.
  4. Submit the claim to WPS MVH (TriWest) within 180 days from the date of the denial by the incorrect VA payer.

Claims that do not meet the above requirements will be denied if submitted after 180 days. TriWest can no longer accept remittance advice documentation from non-VA payers, such as TRICARE, Medicare, or other health insurers.

Remember, providers are not allowed to balance bill Veterans or TriWest for services provided under the Community Care Network contract, including any remaining balances after a timely filing denial.

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Change to CCN’s Appointment and Authorization Process

Based on a recent change in the Veteran appointment process along with the rollout of the Department of Veteran Affairs (VA) Community Care Network (CCN) in Region 4, network providers might receive authorization letters generated by either VA or TriWest Healthcare Alliance, depending on which entity appoints. However, this should not affect the care that needs to be rendered to the Veteran.

Under CCN, there are three pathways for an appointment:

  • Directly from a VA Medical Center (VAMC)
  • Directly from TriWest
  • Veteran self-appointed

When a VAMC appoints, VA generates the authorization letter using its own letterhead. Similarly, when TriWest appoints, TriWest generates its own authorization letter using its own letterhead. Regardless of which entity appoints and generates the authorization letter, it will be in a Standardized Episode of Care (SEOC) format. This format bundles the standard services covered with a procedure or type of care. Each specialty (e.g., cardiologist, chiropractor, etc.) has its own version of a templated SEOC authorization.

To find a listing of all SEOCs by profile (type of care), please click on the VA’s SEOC code list for covered CPT codes and other similar information.

Additionally, providers may check the status of an approved referral/authorization (no matter from a VAMC or TriWest) using VA’s secure, web-based system, HealthShare Referral Manager (HSRM).

Here are important points to remember about the appointing process:

  • The provider must have an approved referral/authorization from either a VAMC or TriWest before an appointment can be made.
  • Except for urgent or emergent care, providers should not administer care that does not have an approved referral/authorization from either VA or TriWest; otherwise, they risk not being reimbursed.
  • TriWest or VA generates approved referral/authorization information with all appointment details, authorization/referral number and scope of care upon appointment confirmation.

For more information, refer to the CCN Appointing Processes Quick Reference Guide.

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Remember the Emergency Care Notification Process

Providers treating Veterans who self-present to an emergency department are required to notify the Department of Veterans Affairs (VA) within 72 hours of care being rendered.

Community hospitals and providers should use the following methods to notify VA through a new centralized location, the Community Care Centralized Call Center, which is staffed and operated by Office of Community Care (OCC):

Once notification is received and reviewed by VA using the eligibility criteria, treating community providers will receive authorization decision information and, if applicable, instructions on how to submit claims.

This process allows VA to assist the Veteran in coordinating necessary care or transfers, and helps ensure that the administrative and clinical requirements for VA to authorize TriWest to pay for the care are met. This process applies to providers participating in Patient-Centered Community Care (PC3) and the Community Care Network (CCN).

Please note that providers may not collect any co-pay, cost-share, or deductible from a Veteran as part of this benefit.

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Provider Handbook Updates

There are no planned changes to the PC3 or CCN handbooks in October 2020.

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Updated: 10/2/2020 4:18:43 PM