Veterans Affairs Community Care Program Frequently Asked Questions

Veterans Affairs Community Care program Frequently Asked Questions

Background

On Sept. 4, 2013, TriWest Healthcare Alliance (TriWest) was awarded a 5-year contract by the Department of Veterans Affairs (VA) to administer the VA Community Care program, Patient-Centered Community Care (PC3).

The purpose of the program is to enhance access to health care services for Veterans by making a quality provider network available closer to a Veteran's home. Access to care through the Community Care program is only available to eligible Veterans following a referral from a VA Medical Center that is processed by TriWest.

In September 2018, VA asked TriWest to quickly stand up a provider network, claims processing and payment facilitation, medical administrative management, and customer services support of Veteran community health care across the entire nation on an interim basis, until the next generation of VA community care – Community Care Network (CCN) – is implemented. Starting on July 29, 2019, portions of the country began transitioning to the other Third Party Administrator (TPA), Optum, to phase in the next generation of this work in three of the six CCN Regions – Regions 1, 2 and 3. We anticipate the transition to this TPA in these regions will be finalized sometime in mid-2020. TriWest will transfer current authorizations to help ensure there is no impact to Veterans’ access to community care during this transition.

On Aug. 6, 2019, VA awarded TriWest Healthcare Alliance a contract to administer the new Community Care Network (CCN) in Region 4. The geographic area we will be serving in CCN includes the following 13 states: Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Texas, Utah, Washington, and Wyoming. TriWest will phase in the new contract for CCN Region 4 over the next year, in close coordination with VA. TriWest is responsible for building and maintaining a network of community health care providers, paying claims, and providing customer service under the CCN contract.

Frequently Asked Questions (Pertaining to PC3)

What types of care may be provided to me through the Patient-Centered Community Care program?

What types of care are not included in the Patient-Centered Community Care program?

In general, what are the determining factors for a VA facility to initiate an authorization for care through the Patient-Centered Community Care program?

What is TriWest's role under the Patient-Centered Community Care program?

Who do I contact if I have questions about my appointment provided by TriWest through the Patient-Centered Community Care program?

How are the Patient-Centered Community Care program contracts managed?

What are TriWest's service areas?

In September 2018, the U.S. Department of Veterans Affairs (VA) asked TriWest Healthcare Alliance (TriWest) to quickly stand up a provider network, claims processing and payment facilitation, medical administrative management, and customer services support of Veteran community health care across the entire nation on an interim basis, until the next generation of VA community care – Community Care Network (CCN) – is implemented. Starting on July 29, 2019, portions of the country began transitioning over to the other Third Party Administrator (TPA), Optum, to phase in the next generation of this work in three of the six CCN Regions – Regions 1, 2 and 3. We anticipate the transition to this TPA in these regions will be finalized sometime in mid-2020. On Aug. 6, 2019, VA awarded TriWest a contract to administer the new Community Care Network (CCN) in Region 4. VA has not yet awarded CCN Regions 5 and 6:

TriWest Healthcare Alliance Department of Veterans Affairs (VA) Patient-Centered Community Care (Community Care program) Map

What determines my eligibility for care under the Patient-Centered Community Care program?

What communication options are available for Veterans with hearing or speech disabilities?

TriWest is pleased to offer options to help Veterans with hearing or speech disabilities communicate telephonically.

711 for Telecommunications Relay Service: Our Contact Centers accommodate calls from the Telecommunications Relay Service (TRS). TRS is available in every state, as well as Guam, American Samoa, and Northern Mariana Islands, at no additional cost to the caller, and provides basic relay services to hearing or speech disabled individuals using text telephone (TTY) devices. To communicate with TriWest using this service, please use your TTY or dial 711 on your telephone.

AT&T National Relay Service: Our Contact Centers also accommodate calls from the AT&T National Relay Service. The AT&T National Relay Service is available at no additional cost to the caller and covers a range of communication methods. To communicate with TriWest using this service, please use the following resources:

  • TTY Users: (800) 855-2880
  • Voice Users: (800) 855-2881
  • PC (ASCII) Users: (800) 855-2882
  • Telebraille Users: (800) 855-2883

Are medications covered under the Patient-Centered Community Care program?