TriWest Provider Pulse - March 2019
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Provider Pulse: March

Provider Pulse

March 2019

Welcome to March

We’re marching into spring with several helpful topics in the March edition of Provider Pulse. Our claims processor WPS MVH is transitioning all Regions to a single Payer ID – VAPCCC3. New providers have a variety of resources to help them with any questions. We now have pre-recorded webinars available for you whenever your schedule permits. Read all about these topics, and more, below.

In This Edition:

Moving to a Unified Payer ID for Community Care Network!

WPS Military and Veterans Health (WPS MVH) is TriWest’s claims processor for the Department of Veterans Affairs’ (VA) Veterans Choice Program (VCP) and the Patient-Centered Community Care (PC3) program. Until recently, WPS MVH had different Payer IDs for both the VCP and PC3 programs. Payer IDs varied from one clearinghouse partner to another and also varied by Region (Regions 3, 5, and 6).

With TriWest’s expansion to nationwide administration of VCP and PC3 programs, this has all changed! WPS has been reaching out to trading partners and clearinghouses to transition all Regions (Regions 1, 2, 3, 4, 5 and 6) to a single Payer ID – VAPCCC3. This single ID is now accepted from any clearinghouse as well as for any direct claims submissions. To verify which Region you are in, please take a look at the Regions map for the VA community care programs.

Claims submitted with the older Payer IDs will still be accepted and paid until the transition to a unified Payer ID is complete and all trading partners/clearinghouses are using VAPCCC3. To ensure your claims are submitted correctly so you can be paid quickly and efficiently, be sure to work with your clearinghouse and verify that they have moved to the unified Payer ID – VAPCCC3.

Join Us to Learn More!

To learn more about registering for electronic claims, which is also referred to as electronic data interchange (EDI), please visit TriWest’s dedicated billing page. We also have links directly to the WPS EDI Enrollment page, a clearinghouse look up tool and other billing-related information for providers. You can also sign up for a live webinar or view on-demand modules from TriWest’s Payer Space in Availity®.

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Resources Available for New Providers

TriWest continues to assist VA in administering the PC3 and VCP as we temporarily expand our PC3 and VCP responsibilities into the territory previously handled by Health Net Federal Services (HNFS). If you are a provider who is new to TriWest, welcome!

What Do You Need to Do?

Help is Available!

We have a team of representatives at 1-866-245-3820 waiting to assist you with any questions you may have as we temporarily expand our PC3 and VCP responsibilities into the territory previously handled by HNFS.

Here are some resources to help you:

Your participation in the network is greatly appreciated. Thank you for joining our mission and proudly caring for Veterans within your community!

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Pre-Recorded Webinars Now Available On-Demand!

Need help understanding how the VA community care programs work, but don’t have time to sign up for a webinar?

Now you don’t have to! TriWest Provider Education pre-recorded all of its live, interactive webinars and turned them into on-demand, eSeminar modules you can take any time – on YOUR schedule.

The on-demand eSeminar topics include processes for both Regions 3, 5 and 6 and the expansion Regions 1, 2 and 4. Don’t know your Region? You can take a quick look at VA’s Regions for the community care programs on TriWest’s website, or check out the Regions map.

Where to Access the eSeminars

The eSeminars are available through the TriWest Payer Space on Availity at www.availity.com. Follow these steps to get there:

  1. Log in to www.availity.com.
  2. Navigate to the TriWest Payer Space.
  3. Click the app titled, “TriWest Learning Center.”
  4. Navigate to “My Courses,” and click the course you want to take.

REMEMBER! Processes and procedures for Regions 1, 2 and 4 are different from the processes and procedures for Regions 3, 5 and 6. If the eSeminar is not labeled for your Region, or all Regions, it may not apply to your area. You should only take courses that apply to your Region to get the correct training.

If you prefer to register for a live, interactive webinar where you can ask questions, those are still available. Visit Availity and sign up!

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Getting Compliant with Claims

To ensure you get paid promptly, remember that the VA community care programs follow the Centers for Medicare and Medicaid (CMS) guidelines for most claims.

Two areas where we have seen some issues are unattended home sleep studies and home health services.

Home Sleep Tests and G-Codes

There are two main components for an unattended home sleep test (HST) – the actual study and the interpretation of the study data.

To be compliant with Medicare, an unattended HST should be billed with HCPCS code G0398, G0399 or G0400, modifier TC and place of service (POS) 12. This indicates the technical component took place in the patient’s home. These codes include the testing and the work of instructing the patient how to use the equipment. The date of service should be when the sleep study device is applied.

The test interpretation should be billed with procedure G0398, G0399, or G0400 and modifier 26, indicating this is the professional component. For this code the POS should also be 12, since this is where the technical component took place and there was no face-to-face component. The date of service is the date the sleep study is interpreted.

CPT codes 95800, 95801 and 95806 should be billed when sleep study is performed in a facility. These codes should never be billed with POS 12.

Home Health Services with Rural Add-On Payments

The Bipartisan Budget Act of 2018 increased the payments for home health that is provided in a rural area. To help track this, Section 50208 of the Act requires all claims for home health services provided after Jan. 1, 2019 contain a code for the county in which services were provided.

To be compliant with CMS billing requirements, home health providers must submit value code “85” with the state and county code of the place of residence where the home health service was delivered in the amount field.

Please visit the CMS website to read more about the Bipartisan Budget Act or download the Medicare Learning Network (MLN) resource on Home Health Rural Add-On Payments. You can also look up the FIPS State and County codes on the Federal census website.

Please double check that your claims are compliant with these policies! Noncompliant claims will be denied or rejected.

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WPS Health Solutions – Now Participating with CAQH Enroll Hub!

Making the enrollment process both easier and faster, WPS Health Solutions is now partnering with the nationally recognized Committee for Affordable Quality Healthcare (CAQH). As the not-for-profit leader in improving process and reducing costs, CAQH not only simplifies the credentialing process, they also simplify the payment process!

No longer do you need to submit banking information to each insurance plan or payer. EnrollHub®, a CAQH Solution®, combines enrollment capabilities for electronic funds transfer (EFT) and electronic remittance advice (ERA). This means you can use a single, secure online process to enroll for electronic transactions with multiple health plans. Not only can you do this all at once, but it is at no charge to your practice!

Are You Enrolling With WPS for EDI Transactions?

If you are in Regions 1, 2 and 4, you may find your clearinghouse is not yet set up for the Veteran programs with WPS MVH. If so, you can enroll for WPS EDI under Region 3 information. Simply use the Region 3 Trading Partner ID and the 5-digit Region 3 Payer ID that have been used historically. You can look this up on the WPS website or you can view it in the Clearinghouse Lookup Tool on TriWest’s provider portal. This allows you to move forward with submitting claims and getting paid.

CAQH Has Tools:

CAQH is dedicated to providers! If you have questions about setting up an account or getting your WPS MVH claims set up through EnrollHub, you can contact CAQH directly from 7 a.m. to 9 p.m. EST Monday through Thursday and 7 a.m. to 7 p.m. EST on Fridays.

CAQH Provider Help Desk:

If you already have an account set up through EnrollHub, be sure to add the PC3 programs that pay through WPS MVH.

If you have not yet set up an account, get started today to save time and get paid faster!

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Provider Handbook Updates

There are no planned changes to the Provider Handbook for April 2019

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