VA Provider Notification Center
December 15, 2017
IMPORTANT: New Update to Claims Filing Deadlines – Phase III
As of February 1, 2018, TriWest will no longer accept claims with a date of service (DOS) prior to June 30, 2017.
This is our third phase of communications about timely filing requirements – reminding our providers of the need for timely filing to avoid any negative impact on your practice revenue. As you know, TriWest has always encouraged providers to submit claims within 30 days of rendering services.
What does this mean for you?
If you have outstanding Patient-Centered Community Care (PC3) or Veterans Choice Program (VCP) claims, claims you need to send for reconsideration/appeal, or claims you need to send to TriWest as a secondary payer, please submit them as soon as possible.
- As of September 1, 2017, claims with a DOS for 2014 and 2015 are no longer accepted.
- As of December 1, 2017, claims with a DOS between January 1, 2016 and September 30, 2016 are no longer accepted.
- Outstanding claims with a DOS from October 1, 2016 through June 30, 2017 must be submitted by February 1, 2018 to be considered for payment.
- For all claims with a DOS on or after July 1, 2017, TriWest will enforce the VA’s 180-day timely filing requirement. This means that any PC3 or VCP claims with DOS on or after July 1, 2017 must be submitted within 180 days to be considered for payment.
Claims denied for timely filing cannot be billed back to the Veteran or VA.
Overall, the sooner you submit your claims, the better! Submitting claims within the suggested 30-day timeframe helps VA in monitoring budget and utilization. It also reduces carrying costs for your practice and improves cash flow.
September 18, 2017
IMPORTANT: New Update to Claims Filing Deadlines – Phase II
As of December 1, 2017, TriWest is not accepting claims with a date of service prior to June 30, 2016.
This is our second phase of communications about timely filing requirements – reminding our providers of the need for timely filing to avoid any negative impact on your practice revenue. As you know, TriWest has always encouraged providers to submit claims within 30 days of rendering services.
What does this mean for you?
If you have outstanding claims, claims you need to send for reconsideration/appeal, or claims you need to send to TriWest as a secondary payer, please submit them via the submission process outlined in the Provider Claims Quick Reference Guide.
Outstanding claims with a date of service prior to June 30, 2016 will be denied for timely filing if not submitted by December 1, 2017. This is in compliance with Department of Veterans Affairs (VA) program requirements. Outstanding claims with a date of service prior to January 1, 2016 will be denied for timely filing after September 1, 2017. Claims denied for timely filing cannot be billed back to the Veteran or VA.
Overall, the sooner you submit your claims, the better! Submitting claims within the 30-day timeframe helps VA in monitoring budget and utilization. It also reduces carrying costs for your practice and improves cash flow.
September 7, 2017
Subject: Acupuncture and Chiropractic Changes
Are you a provider treating highly rural Veterans? We have some changes you should know about.
TriWest now provides additional clinical review for Secondary Authorization Requests (SAR) for both acupuncture and chiropractic episodes of care.
How Will This Work?
- Your practice receives an authorization –Standard Episode of Care (SEOC) or Veterans Choice Program profile – for a Veteran meeting the 40-miles from a VA facility eligibility rule.
- You determine that additional care is necessary and submit a SAR, along with supporting documentation, to TriWest.
- TriWest conducts clinical review and utilization management for chiropractic care and acupuncture.
- TriWest submits approval or denial back to your practice directly. This reduces wait time and additional review requirements by VA.
Have you reviewed the SEOC authorization template for chiropractic care? This template allows a pre-approved range of services and visits over a 12-month period. If you have additional questions about SEOCs or Choice profiles, these tools are located on TriWest’s Provider Portal under Provider Resources. Please take a look.
July 17, 2017
Subject: Update to Claims Filing Deadlines
As of Sept. 1, 2017, TriWest will no longer accept any claims with a date-of-service prior to Jan. 1, 2016.
As you know, TriWest has always encouraged providers to submit claims within 30 days of rendering services. Although TriWest had made exceptions to that rule in the past, we will now stop accepting claims prior to Jan. 1, 2016.
What does this mean for you?
If you have outstanding claims you still need to submit, or claims you need to send for reconsideration, send them via the submission process outlined in the Provider Claims Quick Reference Guide by Sept. 1, 2017. Any claims with a date-of-service prior to Jan. 1, 2016 that are submitted after Sept. 1, 2017 will be denied, and you may not bill the Veteran.
Overall, the sooner you submit your claims, the better! Submitting claims within the 30-day timeframe will help to increase your cash flow, as well.
November 23, 2016
Subject: Updates to TriWest Provider Portal
TriWest has made some updates to the public-facing and secure-facing ends of its Provider Portal. For your information, those changes are as follows:
- New billing section on the public-facing side of the Provider Portal
- Claims navigation updates on the secure-facing side of the Provider Portal
- Estimated date of payment
- Date received
- Date of payment disclaimer
- Renaming the denial reason column
- Authorization navigation update on the secure-facing side of the Provider Portal
- Created a “contact activity” modal for each authorization
Should you run into any technical issues, please call our Provider Portal Assistance Line at 1-855-722-2838, x3, x2 or email VAPortalAssistance@triwest.com
July 15, 2016
Subject: New Address for Claims Submissions
Starting Aug. 1, 2016, the mailing address where providers send paper claims for the Department of Veterans Affairs Patient-Centered Community Care Program and Veterans Choice Program will be changing to:
PO Box 7926
Madison, WI 53707-7926
The old address was for a location in El Paso, TX, whereas the new address goes to Madison, WI. Please keep in mind you may encounter an overlap of addresses on the Veterans Choice Card during this transition. The old cards still list the former address, while the new cards will list the updated address. For more information on the claims submission process, please review our Provider Claims Quick Reference Guide.
May 23, 2016
Subject: Updated CPT Codes for Authorization Letters
The list of approved CPT codes referenced in all TriWest authorization letters under the “appropriate Medicare-covered services” language has been updated as of May 20, 2016. Please visit the updated list of CPT codes at www.triwest.com/provider/authorization-codes.
March 21, 2016
Subject: Program Changes to Medical Documentation Requirements FAQs
The Department of Veterans Affairs (VA) made an important modification to the Veterans Choice Program (VCP) as of March 1, 2016 affecting requirements for medical documentation. Among the most important changes: TriWest may now reimburse providers’ claims before receiving medical documentation. However, VA still requires medical documentation to ensure coordination of care for Veterans. Therefore, you must still submit all medical documents. Providers will have more time to submit medical documentation to TriWest:
- Outpatient care – 75 calendar days
- Inpatient care – 30 calendar days
- Urgent care – 2 business days
Please note: These changes affect the VCP only, and do NOT affect the Patient-Centered Community Care Program (PC3). Please click here for more information.
March 1, 2016
Subject: Important Provider Notification for Veterans Choice Program Providers
On behalf of TriWest Healthcare Alliance, I want to personally thank you for your commitment to serve the community health care needs of our nation’s Veterans. I am pleased to inform you of an upcoming change that will help you get paid for services more timely under the Veterans Choice Program (VCP). VA has listened to our concerns about challenges in processing claims and has demonstrated its commitment to making the program work better by implementing what we believe will be a welcome change for providers! Soon you will have more time to submit medical documentation for care provided under VCP and we will have the authority to pay claims in advance of receiving the medical documentation.
Instead of 30 days to return medical documents, providers will have 75 calendar days to return medical documentation for initial and final visits for outpatient care. TriWest is currently putting the final processes in place to effectively implement this new guidance from VA. We have worked hard for this positive change and are excited to share more detailed information with you over the coming weeks as this is implemented. Again, thank you for all you do to care for our nation’s Veterans.
February 18, 2016
Subject: Medical Documentation Required with All Claims
To ensure your claims are complete and you receive payment, be sure to upload your corresponding medical documentation to TriWest’s Secure Provider Portal. After signing into your account, select the “UPLOAD MEDICAL DOCUMENTATION” option on the left-hand menu. If you’re waiting on payment for a claim that’s missing medical documents, please submit those documents to TriWest immediately.Should you have trouble accessing the Provider Portal, you may fax medical documentation to TriWest at 1-866-259-0311. Need assistance navigating the Provider Portal or submitting claims to TriWest? Sign up for a live webinar with a TriWest Provider Education Specialist.
February 16, 2016
Subject: Improving Access to Care for America’s Veterans Through the Veterans Choice Program
Dear Providers: Thank you for supporting the vital work of the Department of Veterans Affairs (VA) by ensuring that every Veteran in every community we serve receives timely and high and quality care. Below is a summary of some recent changes made to both the Veterans Choice Program (VCP), as well as internal process changes TriWest has implemented in an effort to increase Veteran access to care and reduce administrative burdens on your practices. Please click here for more information.
December 31, 2015
Subject: Authorization Letter Changes
TriWest Healthcare Alliance has enhanced our provider authorization letters, based on the valuable feedback received from our network providers. As such, you may notice your authorization letter has changed significantly. We are hopeful these changes are beneficial to you as you continue to provide health care to our nation’s military Veterans. Please click here for more information.
October 21, 2015
Subject: Balance Billing Veterans
As a reminder, providers cannot balance bill Veterans who have received care under Patient-Centered Community Care (PC3) or Veterans Choice Program (VCP). Veterans are not responsible for co-pays or cost-shares under these programs. As such, a Veteran may not be billed directly for any services or supplies furnished under PC3 or VCP.VA regulations also prohibit PC3 providers from charging missed appointment fees. Providers may submit claims for PC3/VCP authorized services on behalf of Veterans and use best efforts to submit clean claims within 30 days after services have been rendered. Services that have been authorized by VA and TriWest will be reimbursed as soon as complete medical documentation has been submitted for that service. Thank you for your willingness to support and care for our nation’s military Veterans.
October 7, 2015
Subject: ICD-10 Claims
If an authorization appointed after October 1, 2015 with ICD-9 codes on it, will not prohibit an ICD-10 claim from getting paid. Any TriWest authorization does not need to be updated with ICD-10 codes in order for claims to pay. Please submit your claim with the correct ICD-10 codes, and assuming all other conditions are met, the claim will pay. An authorization with ICD-9 codes will not prohibit an ICD-10 claim from getting paid. Please click here for more information.
February 21, 2015
Subject: Password Reset Self-Service Feature
You will now have the ability to request a password reset online. An email with the password reset link will be sent to your valid, registered email address. Please click here for password reset self-service instructions.
January 13, 2015
Subject: Veterans Choice Program (VCP)
My name is Frank Maguire and I am the Chief Medical Officer for TriWest Healthcare Alliance. We have had the honor and privilege of working with providers under the Veterans Affairs (VA) Patient-Centered Community Care (PC3) program since January 2014. Many of you have received referrals directly from the VA under Fee Basis Care and from TriWest Healthcare Alliance under PC3. When you receive either of these referrals you will receive a VA 7079 form authorizing the care along with pertinent clinical information. Both Fee Basis Care and PC3 referrals will continue.The Veterans Choice Program (VCP) is a new addition to the current PC3 program. A key difference between VCP and PC3 is that any eligible Veteran can contact TriWest and ask for assistance getting medical care. They do not need to receive a referral from a VA facility. Because they do not have a referral from the VA there is no 7079 or clinical information from VA provided.
The VCP is similar to Medicare in that the patient can ask to be seen by a Medicare-certified provider who is willing to accept the terms and conditions of the VCP. However, unlike Medicare, Veterans seeking care under the VCP still must have an authorization for that care from TriWest. Both network and non-network providers can be asked to see Veterans under the VCP. As with the PC3 program, TriWest staff will assist the Veteran in getting an appointment with your office, obtain medical documentation, and pay your claims.Some provider offices have been concerned that there is no 7079 from the VA for the VCP. Please be assured that these documents are not necessary for you to see the Veteran under the VCP. Further information regarding the differences between PC3 and the VCP can be found on our provider portal. I would appreciate it if you could inform your staff about the differences between PC3 and the VCP.Thank you for the care you provide to our Nation's heroes.
Frank Maguire, MD
Chief Medical Officer
TriWest Healthcare Alliance
December 20, 2014
By this notification you are hereby informed that TriWest's contract to administer the Veterans Affairs (VA) Patient-Centered Community Care (PC3) program on behalf of the Department of Veterans Affairs was recently amended due to a change mandated by statute. As such, TriWest is required to make changes in the contract between TriWest and its affiliated network facilities and providers.In August, 2014, the U.S. Congress approved the Veterans Access, Choice and Accountability Act of 2014 (VACAA) that provided for a number of changes to benefits for eligible U.S. Veterans.Pursuant to Section VI.A "Amendments" of your agreement, you are hereby notified that the additional requirements under VACAA are hereby incorporated into all Network Provider contracts effective immediately. You should be advised that there changes do not affect the rates paid to you for services under your provider agreement.
If you have any questions regarding this notification, please feel free to contact TriWest at 855-722-2838.