TriWest Selects PGBA for New VA Community Care Network Claims Processor

Phoenix, AZ (March 29, 2021) – TriWest Healthcare Alliance has selected PGBA to be the subcontractor for claims processing and payment services for the U.S. Department of Veterans Affairs (VA) Community Care Network (CCN) in Regions 4 and 5.

CCN is a network of credentialed community health care providers who work with VA medical professionals. TriWest, the prime contractor for VA’s CCN Regions 4 and 5, selected PGBA based on its proven track record of past performance in health care claims processing for government. PGBA represents more than 40 years of continuous service in health care claims administration, operations management, and government contracting. PGBA has supported the Department of Defense’s TRICARE program and, more recently, VA’s CCN claims for Regions 1-3.

TriWest President and CEO David J. McIntyre, Jr. states, “We are committed to working closely together with our current claims processing subcontractor to help ensure a smooth transition and minimize the impact to medical providers in our network.”

The first step in the transition of claims processing will begin on April 1, 2021, when PGBA will begin accepting claims from CCN providers in the Kodiak, AK (Region 5) area. PGBA will process all CCN Region 5 claims on behalf of TriWest once all of Region 5 transitions to CCN in mid-June. The transition of claims processing for the 13-state CCN Region 4 is scheduled to begin in June 2021.

“As we look to start health care delivery under our new CCN Region 5 contract in the great state of Alaska, we saw this as the opportune time to re-evaluate our operating model to deliver on our commitments under our government contract responsibilities,” said McIntyre. “We are confident in the partnership we’ve established with PGBA under this new vehicle of delivering care and thank our network of medical providers who continue to care for Veterans in the community when VA cannot deliver that care directly.”

Claims processing services under Patient-Centered Community Care (PC3) will continue to be handled by the current claims processing provider during the transition. There will be no changes to claims processing services provided for TriWest’s dental network through Delta Dental or its pharmacy network through Express Scripts (pharmacy).