Provider Pulse – November 2024
We’re Listening! Share Your Thoughts with Us!
TriWest Healthcare Alliance (TriWest) is committed to enhancing your experience when sending medical records to the Department of Veterans Affairs (VA) for Veterans you treat under the Community Care Network (CCN).
Please complete this quick, three-question survey. Your responses are anonymous and will help VA and TriWest identify opportunities for improvement.
Thank you for your time and your valuable feedback. Most importantly, thank you for helping to care for the Nation’s Veterans!
Assignment of Benefits Required for VA CCN Claims
As a reminder, a Signature on File, also known as the Assignment of Benefits, is required for any Veteran who receives care under the Department of Veterans Affairs (VA) Community Care Network (CCN). Providers will be selected at random for quarterly audits conducted by TriWest.
What is an Assignment of Benefits?
An AOB is a document signed by the Veteran stating that a claim may be submitted for the Veteran by the provider and that the provider will receive payment directly from the Veteran’s health plan third-party administrator. The Veteran is not involved in the payment process.
Providers must keep a signed AOB on file for each Veteran whose services are billed to a third-party administrator. The AOB must be saved for auditing purposes and updated at least once per year.
How will I know I’m selected for an audit?
If you are selected for an audit, you will receive a letter with a list of Veterans from TriWest. You will need to provide a copy of the AOB for each Veteran included in the letter. TriWest may also contact your office via phone to gather this information.
Providers must submit the AOB and any supporting documentation within 30 days of receiving a Request for Assignment of Benefits letter. You can submit AOB documentation by:
- Email: CCNAOB@triwest.com
- Fax: 866-286-4177
- Mail:
TriWest Healthcare Alliance
Attn: CCN Claims - AOB
P.O. Box 42270
Phoenix, Arizona 85080-2270
Please note: If you prefer mail an AOB, it must be received by TriWest within 30 days of the date the Request for Assignment of Benefits letter was sent.
If you have any questions, please contact our VA CCN Contact Center at 1-877-226-8749.
Qualifications for the High Performing Provider Designation
VA designates CCN providers who exceed the standards of provider practice as High Performing Providers (HPP).
Provider performance is analyzed and monitored against a standard of quality metrics determined by TriWest, including clinical outcomes, patient satisfaction, cost-effectiveness, and adherence to established guidelines. Providers can achieve the HPP designation by consistently meeting or exceeding measures of performance expected under the guidelines set forth by Blue Health Intelligence and Centers for Medicare and Medicaid Services (CMS).
VA staff consider the HPP designation during the Veteran appointment scheduling process to help Veterans select a community provider.
Scoring and Eligibility
VA’s HPP designation applies to individual practitioners, practitioners in a group setting, and institutional providers, such as hospitals. The three types of providers are scored differently:
- Individual providers are evaluated based on Primary Care and Specialty Measures from Blue Health Intelligence.
- Provider practice groups are scored as a single entity, and providers in those groups are assigned the score of the overall group.
- Institutional providers are scored on a selection of CMS measures from the Hospital Compare system.
HPP only applies to a certain subset of specialties, so not all specialty providers are eligible for the designation.
There is no action required by providers. The HPP designation is informative and not an endorsement or a guarantee of a provider’s ability to provide health care services.
Resources
A summary of your specific provider metric results is available on request by completing the CCN HPP Inquiry Form. Send the completed HPP Inquiry Form to CQHPP@TriWest.com.
For more information on the HPP designation, please review the HPP Quick Reference Guide and CCN Provider Handbook.
Signatures Required on all Requests for Service
As a reminder, please be sure to include a provider’s signature (written or electronic) on all Requests for Service (RFS) before submitting them to your authorizing VA Medical Center (VAMC).
An RFS Form (10-10172) is a provider-generated request for new or additional care under the VA Community Care Network (CCN) for a Veteran patient.
To avoid potential care delays, please sign and date the RFS Form on the initial submission. Forms received by VA without your signature will not be processed and will be returned to you. If this happens, you must then sign the form and resubmit it to VA.
Please continue to submit an RFS to your local VAMC for the following:
- Additional visits or time beyond what is authorized in an active referral (for example, the current authorization is expiring).
- A new specialty service referral.
- An additional procedure or service not included in the original SEOC.
Please note that the RFS section of the CCN Provider Handbook will be updated with more information that explicitly outlines this requirement.
You can find the RFS form on VA’s Request and Coordinate Care website. For more information, contact the RFS team by emailing RequestForServiceSupport@va.gov.
VA CCN Provider Handbook Updates
The RFS section of the CCN Provider Handbook will be updated to outline the signature requirement when submitting a Request for Service (RFS).