Provider Pulse – August 2024
Check the Status of Your Claims Electronically through Availity
Under the Department of Veterans Affairs (VA) Community Care Network (CCN), providers can check the status of claims through Availity. This tool gives providers a more intuitive and robust workflow to check the claim status of Veteran patients.
To check the status on a claim:
- Login to Availity.
- Click on Claims & Payments in the top-left corner of the main screen.
- Under Claims & Payments, select the Claim Status option. The Claim Status tool allows providers to check the status of a submitted claim and view remittances.
Providers can also search claims by member ID, tax ID service date, and claim number.
If a claim cannot be found, there may have been errors with the submission. If a claim is visible, it is in process. Please do not resubmit for in-process claims.
For missing claims, please first verify that:
- It has been at least 10 business days since you uploaded the claim or 15 business days since the provider mailed the claim.
- A paper claim was not handwritten, and all information was typed correctly.
If you have problems checking your claims status, use the secure "Chat with TriWest" feature on Availity, or call TriWest Claims Customer Service at 877-CCN-TRIW (877-226-8749) from 8 a.m. to 6 p.m. in your time zone.
Reminder: Do Not Bill Veterans for Fees, No-Shows Under CCN
Please remember that Veterans should not be charged directly for any medical procedures or fees under the VA Community Care Network (CCN).
If issues persist regarding no-shows or coverage for authorized procedures, please contact the VA Nurse Manager listed on the referral/authorization for assistance.
Please remember the following:
- Do not balance bill Veterans or TriWest for services provided under the CCN contract. A payment for authorized services under this contract is always deemed payment in full.
- Do not charge a Veteran for not keeping a scheduled appointment.
- Do not solicit Veterans or VA Medical Center (VAMC) for services.
For reference, please review the Provider Responsibilities to Veterans subsection of the Veteran Eligibility and Covered Services section of the Provider Handbook.
See the Latest Clinical Determinations and Indications on VA’s Community Care Website
The Department of Veterans Affairs (VA) publishes medical policies for community care providers to help ensure that recommended care meets VA clinical criteria. The policies help guide providers but are not intended to replace clinical judgment. The policies also do not affect provider reimbursement for care.
To view VA's most current medical policies, visit the Clinical Determinations and Indications page on VA's website. For more detailed information, take the Medical Policy webinar on VHA TRAIN.
VA Opioid Safety & Military Culture Training for Providers
Opioid safety information and training is a part of the Department of Veterans Affairs (VA) Opioid Safety Initiative. The initiative is a comprehensive strategy to reduce reliance on opioid medications and improve effectiveness and safety for Veterans.
VA recognizes the clinical challenges to successfully managing pain and prescribing safely for Veterans while implementing the Opioid Safety Initiative Directive and the Informed Consent Directive. An Opioid Safety Toolkit (evidence-based to the extent possible) was created by the National Pain Management Program office to help guide you. This toolkit contains documents and presentations that can aid in your clinical decisions about starting, continuing, or tapering opioid therapy, and other challenges related to safe opioid prescribing. Topics include:
- Safe and Responsible Use of Opioids for Chronic Pain - A Patient Education Guide
- Effective Treatments for PTSD: Consider Cognitive Behavioral Therapy (CBT) as First Line Treatment - for Clinicians
- Effective Treatments for PTSD: Helping Patients Taper from Benzodiazepines - for Clinicians
- Benzodiazepines Overview - for Patients
- Cognitive Behavioral Therapy for Chronic Pain - Therapist Manual
- Consent Form for Long-Term Opioid Therapy for Pain
Here are the steps to access the Opioid Safety Initiative Training:
- Create a VHA TRAIN account.
- Take course 1086479.
- Reserve approximately 20-30 minutes to complete.
- Read VA’s Opioid Safety Document.
Military Culture Training
VA also recommends that CCN providers take the military culture training course Community Care Provider-A Perspective for Veteran Care. This training emphasizes the importance of understanding military culture and experiences to improve treatment outcomes for Veterans.
According to VA, Veterans seen by culturally informed providers reported they were more satisfied with their visit and, therefore, more comfortable seeking and sharing information about their health care needs.
Providers will receive one hour of Accreditation Council for Continuing Medical Education (ACCME) accreditation for completing the military culture training.