Veterans Choice Program: Improving Access to Care for America's Veterans
Episode of Care Limitations
Initial Choice program requirements limited authorizations to 60 calendar days for all services. We received much feedback that this was a significant impediment for providers, who had to spend additional time submitting requests for care extension authorizations for Veterans who were in the midst of chemotherapy treatments, chronic conditions and even pregnancies. Last fall, Congress and VA modified the operating parameters, and TriWest received approval in January 2016 to authorize care based on the clinically appropriate episode of care up to one year. We are hopeful this change will reduce hassle on your end by decreasing the paperwork (e.g., SARs) needed from provider offices in order to continue treatment for Veterans in need.
“Point of Sale” Provider Education
TriWest offers a suite of provider education, both on-demand and through live webinar discussions through our Provider Education department. We recognize that you have limited time and need to know “the basics” when it matters most—when a Veteran is scheduled for an appointment in the office. As of December 2015, providers now have access to the following:
- “Point of Sale” provider education which streamlines pertinent information.
- A new 1-page Program Overview outlines the key points of the appointment process, medical documentation guidelines, and how to ensure quick and easy payment of claims.
- A new Face Sheet reminding you of critical information to send to TriWest which can be used as a fax cover sheet for fast communication.
- The Program Overview and Face Sheet now accompany every authorization letter you receive, once a Veteran is scheduled for care.
Provider Authorization Letter Redesign
Effective January 2016, in order to minimize confusion regarding which services are covered/authorized, TriWest has re-engineered the authorization letter.
- Expanded medical profiles helps ensure routine services associated with a patient’s diagnosis are included up front with an authorization for care sent to a provider, thus minimizing the need to send TriWest paperwork for a Secondary Authorization Request (SAR).
- Office-based procedures necessary to evaluate and/or treat the Veteran are covered unless specifically excluded in the clinical documentation provided by VA.
- Specialty-specific provider education is customized on the letters to help relay program requirements.
Provider Contact Center Enhancements
Streamlining issue resolution and being available to answer your questions quickly and accurately is a key component of TriWest’s commitment to enhancing your experience working with us. Your feedback has prompted TriWest to carry out several operational changes.
- As of November 16, 2015, TriWest has assigned Provider Services staff to directly answer all provider calls associated with Choice Program contracting in order to increase first-call resolution and minimize phone transfers.
- Provider Services’ hours of operation were extended in mid-November and staffing was increased to accommodate the volume of calls into a single department.
- An “Escalation Group” of Patient Service Representatives (PSR) is now dedicated and trained to respond to your authorization needs.