Provider Pulse – May 2024

Make Life Easier – Enroll in HSRM to Access VA’s Referral Network

The Department of Veterans Affairs (VA) HealthShare Referral Manager (HSRM) helps community providers and VA better manage community care for Veterans. This secure web-based system simplifies and streamlines the Community Care Network (CCN) referral and authorization process, as well as the process for uploading medical documentation.

By utilizing HSRM, CCN providers can expect shorter wait times when contacting the authorizing VA Medical Center (VAMC) regarding Veteran care.

There are many benefits provided by HSRM, including:

  • Helps facilitate Health Information Exchange (HIE) between community providers and VA via one unified platform.
  • Enables flexibility to more easily refer Veterans for other specialized care.
  • Allows community providers to submit Requests for Service (RFS).
  • Generates reports to inform decision-making and track workflow.
  • Provides clinical summary of Veterans’ medical history, including details like diagnoses, prior medical procedures and medications, via the Clinical Viewer module.

Registration, training and technical support for HSRM are available to community providers at no cost. Just follow these steps to obtain access to HSRM to enjoy the benefits:

For more information visit VA’s Community Care web page.

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Last Day to Submit PC3 Claims with a Retroactive Referral is June 30

This is a notice to all providers that claims containing a retroactive referral filed under VA’s Patient-Centered Community Care (PC3) must be submitted on or before June 30, 2024.

TriWest Healthcare Alliance (TriWest) administers claims for the current Department of Veterans Affairs (VA) Community Care Network (CCN) in Regions 4 and 5. TriWest has also continued to support VA PC3, the predecessor of CCN, which concluded in Region 4 on March 31, 2021, and in Region 5 on March 31, 2022.

For Current PC3 Claims:

  • Services that fall under a Retroactive Referral must be submitted by June 30, 2024, to be considered.
  • All other PC3 claims requests, unrelated to Retroactive Referrals (adjustments, reconsiderations, recoupments, etc.) are no longer accepted due to PC3 close-out.

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Providers Invited to Attend June Attentional Risk Factors for PTSD Training

The Department of Veterans Affairs (VA) is inviting providers in the Community Care Network (CCN) to enroll in an upcoming training on impaired attentional factors associated with posttraumatic stress disorder (PTSD).

The training will be held on Wednesday, June 5 at 9:00 a.m. HST/11:00 a.m. AKT/12:00 p.m. PST/1:00 p.m. MST/2:00 p.m. CST/3:00 p.m. EST.

Training Purpose:

Attentional factors are commonly impaired among individuals with PTSD, though they are infrequently addressed in treatment. This lecture will delve into the role of attentional risk factors in the development and maintenance of PTSD. Strategies will be presented for intervening to optimize attentional functioning, which may improve treatment engagement and PTSD symptoms. Participating in this lecture will equip clinicians with evidence-based strategies designed to improve quality of life and functioning among those with PTSD.

Learning Objectives:

  1. Describe how attentional factors contribute to PTSD.
  2. Consider how attentional functioning might influence a Veteran’s experience of PTSD and treatment engagement.
  3. Discuss the state of the literature regarding existing interventions for attentional functioning.

If you are a VA provider, please register using the TMS Registration web page. Non-VA providers can register on the VHA TRAIN registration web page.

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Clean Claims Equal Timely Payments

Properly submitting your VA CCN claim in a clean, efficient manner helps the claim process and pay in a timely manner while reducing the chances of it being denied and/or rejected.

The claims process begins once the provider receives an authorization letter from either TriWest or VA. The letter is assigned a VA referral/authorization number which is the unique identifier for each approved referral/authorization’s episode of care. An approved referral/authorization from VA:

  • supports the service rendered by a CCN provider;
  • has a specific plan of care; and
  • details a specified number of visits and/or services related to a Standard Episode of Care (SEOC).

TriWest must have visibility to the appointment via the assigned referral/authorization number in its systems. If the referral/authorization number is not included on the claim, it will be denied and/or rejected.

For more information regarding clean claims as well as the proper documentation on submitting claims to PGBA, refer to the Billing and Claims section of the Provider Handbook as well as the Claims Submission quick reference guide.

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VA CCN Provider Handbook Updates

The following changes are planned for sections of the CCN Provider Handbook.

A new subsection will be added to the Billing & Claims section of the Provider Handbook:

CCN Provider - Agency Agreement With A Third Party Billing Entity

Occasionally, a CCN provider may enter into an agency agreement with a third party to act on its behalf in the submission and the monitoring of CCN claims. Such arrangements are permissible as long as the third party is not acting simply as a collection agency. There must be an agency relationship established in which the agent is reimbursed for the submission and monitoring of claims, but the claim remains that of the provider and the proceeds of any CCN payments are paid to the CCN provider. TriWest may interact with these agents in much the same manner as TriWest interacts with the provider’s accounts receivable department. However, such an entity is not the provider of care and cannot act on behalf of the provider in the filing of an appeal unless specifically designated as the appealing party’s representative in the individual case under appeal. The provider is the party directly contracted with TriWest and cannot assign any rights and responsibilities to a third party unless TriWest agrees pursuant to the terms of the provider’s agreement with TriWest. As such, under the provider’s agreement, any third party billing entity or its legal counsel are not a contracted party and may not pursue direct legal action against TriWest.

The following changes will be made to Item 1 under the Termination subsection of the Credentialing and Contract Provisions section:

  1. Provider’s state or federal license or authorization to do business is reduced, restricted, placed on probation, suspended, involuntarily revoked, involuntarily terminated, voluntarily terminated or voluntarily revoked by Provider to avoid investigation, or voluntarily terminated or voluntarily revoked by Provider while Provider is under investigation in any state, or Provider’s other applicable license or accreditation necessary to perform any services contemplated by the Provider’s Agreement is reduced, restricted, placed on probation, suspended, involuntarily revoked, involuntarily terminated, voluntarily terminated or voluntarily revoked by Provider to avoid investigation, or voluntarily terminated or voluntarily revoked by Provider while Provider is under investigation in any state.

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Updated: 5/30/2024 10:21:19 AM