Provider Pulse

October 2020

Welcome to October

As we begin to fully embrace the fall season, TriWest is here to help providers better understand the VA Community Care Network (CCN) with a full array of training options. Read more about the enhanced flu shot option for Veterans, and how not every CPT code is necessary to render care under a Standardized Episode of Care (SEOC).

In This Edition:

Questions about CCN? TriWest Training is Here to Help!

To help you better understand the unique aspects of the Department of Veterans Affairs (VA) Community Care Network (CCN) and allow you to learn on your own time, TriWest has created a full array of training options via its Learning Center on Availity.com.

Topics include appointing and approved referrals/authorizations, claims submission, requests for service (RFS), and other CCN processes and procedures. The training methods include:

  • Pre-scheduled webinar sessions
  • On-demand eSeminar Learning Paths to fit your schedule
  • Bite-sized MicroLearning videos with insights into CCN

All providers are encouraged to register for a live webinar on CCN. Simply login to Availity, navigate to the TriWest Payer Space, click on the TriWest Learning Center, and register for the webinar session(s) of your choice.

Webinars include:

  • All Inclusive CCN Module – Review all aspects of VA's CCN processes and procedures in a two-hour presentation.
  • Introduction to Community Care Network – Dig into the background information on CCN, including TriWest's role, health benefit package, provider responsibilities and information on Veteran Culture Training.
  • Appointing and Authorizations – Learn the CCN appointing and approved referrals/authorization processes.
  • Claims and Medical Documentation – Find out how to submit a claim, codes and requirements, how to use Availity to submit claims, and medical documentation submission requirements, timeframes and critical findings.
  • Urgent, Emergent Care, DME and Pharmacy Session – Review the steps for the urgent care/walk-in retail location benefit and process flows on emergency care and ancillary providers.
  • Chiropractors, Acupuncturists, Massage Therapists Session – Learn about the recent changes in acupuncture reimbursement, as well as the CCN authorization and claims processes for acupuncture, massage therapy, and chiropractic care for accurate billing and proper payment.

Additionally, TriWest offers eSeminar Learning Paths via Availity. Made to fit your schedule, these on-demand eSeminar Learning Paths cover these CCN topics:

  • Introduction to Community Care Network (CCN)
  • CCN Approved Referrals/Authorizations and the Appointing Process
  • CCN Claims Guidelines

Finally, MicroLearning topics include:

  • What is Community Care Network (CCN)?
  • CCN Health Benefits Package
  • CCN Provider Responsibilities to Veterans
  • CCN Approved Referral/Authorization Process
  • Ways to Get an Appointment
  • CCN Urgent, Emergent or Routine Care
  • Other Educational CCN Resources
  • Pharmacy Processes
  • What is a Request for Service (RFS)?
  • NPI: Why You Need One
  • Ways to File a Claim
  • Timelines for Medical Documentation return to VA

Register for these CCN webinar sessions and eSeminar Learning Paths through the following:

  1. Log in to your account on Availity at www.availity.com (If you don’t have an account, register for one for free.)
  2. Navigate to the TriWest Payer Space
  3. Click on the TriWest Learning Center
  4. Register for the full range of CCN webinars at times that work for you

For help registering for training, see the TriWest Learning Center Quick Reference Guide.

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VA Enhances Flu Vaccine Benefit

As part of the urgent care and pharmacy benefits under the Department of Veterans Affairs (VA) Community Care Network (CCN), eligible Veterans can receive a flu vaccine as a standalone service with no copay. The Urgent Care benefit for CCN began on Sept. 30, 2020.

Eligible Veterans can request a flu vaccine at a CCN network urgent care clinic or retail walk-in location either as a standalone service or in conjunction with another urgent care benefit, at CCN network pharmacies, as well as through a CCN network provider during a visit under an approved referral for other services. Urgent walk-in care services should not include continuous management of conditions, or preventive health services, with the exception of the flu vaccine.

PC3 and CCN Flu Benefits are NOT the Same. Understand the Difference:

Flu vaccines are not a standalone urgent care benefit under Patient-Centered Community Care (PC3) with the exception of Alaska, and are ONLY allowed as an urgent care benefit when received in conjunction with an urgent care visit for another purpose.

The flu vaccine benefit is critical for Veterans, especially during the COVID-19 pandemic. If you are a provider caring for eligible Veterans seeking the flu vaccine, do not turn them away. Instead, use the following guidance:

  • PC3 Pacific Islands: PC3 flu vaccine must be given in conjunction with an urgent care visit for another purpose or with an approved referral.
  • PC3 Alaska Urgent Care: Due to a VA contract modification for Alaska only, PC3 Alaska urgent care providers can give the flu vaccine as a standalone service or in addition to another medical care visit.
  • PC3 Alaska Primary Care Providers and Specialists: Continue to provide flu vaccines to eligible Veterans if there is an active approved referral from VA or TriWest Healthcare Alliance. You should not provide them as a standalone service.
  • CCN Region 4 (includes AZ, CA, CO, HI, ID, MT, NM, NV, OR, TX, UT, WA, and WY.) Network primary care and specialty providers may provide flu vaccines to eligible Veterans during a visit under an approved referral.
  • CCN Region 4 Urgent Care/Retail Walk-In Locations: May provide standalone flu vaccines to eligible Veterans as of Sept. 30, 2020. They can also be provided now and going forward in conjunction with an urgent care visit for other reasons.
  • Follow the current VA National Formulary guidelines.
  • Send claims to TriWest via WPS Military and Veterans Health (WPS MVH). Follow the claims processing procedure outlined in the CCN and PC3 Claims Quick Reference Guides located on Availity to expedite timely payment.

Pharmacists: Flu shots are considered a covered CCN benefit at retail network pharmacy locations without a prescription or copay, but medications must be on the VA-approved Urgent/Emergent Formulary. For additional CCN pharmacy benefits guidance regarding flu vaccines and claims processing, please visit the ExpressScripts Pharmacy Resource Center.

For additional details, please see the TriWest Flu Shot Benefit Quick Reference Guide.

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Not every CPT Code is Necessary on SEOCs for Payment

One advantage of the Department of Veterans Affairs (VA) Community Care Network (CCN) is a focus on reducing the administrative burden placed on community providers, which is demonstrated through a broad interpretation of payable care under a Standardized Episode of Care (SEOC).

Instead of obtaining a direct match of codes for payment, TriWest Healthcare Alliance can now pay codes that are not listed on an SEOC, but that are traditionally covered by Medicare for a specific condition. In addition, VA doesn’t require a code to be added to an authorization for the payment to process, and it no longer adds additional codes to the authorization, either.

If a claim is denied and a provider believes it includes a code that should be paid, here are some insights to help:

  • Verify the reason for the denial. A claim is often denied because of an inconsistency in the submitted claim, not because the code isn’t included in an SEOC. Address that specific denial reason and resubmit the claim, or submit a reconsideration request to TriWest. Submit any documentation to justify the request.
  • Check details like Veteran date of birth, authorization validity dates, units, code modifiers and most importantly, where the claim was submitted. For example, some claims are incorrectly submitted to TRICARE or directly to VA and denied.
  • Reach out to TriWest if a Medicare-payable code denies and the other items appear correct. TriWest wants to pay in a correct and timely manner, and mistakes can happen. TriWest understands the impact of COVID-19 on private practices and hospitals, and doesn’t want to add to any administrative or financial burden.

Remember: Providers only need to submit a request for services (RFS) to:

  • Treat a condition other than what was specifically referred
  • Add practitioners/specialties that wouldn’t usually be involved in the approved care
  • Deliver care that is not normally payable by Medicare

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Reminder: Opioid Safety Training Now a Requirement for Network Providers

The Department of Veterans Affairs (VA) now requires each individual provider within a practice or group who has a DEA number, and who can prescribe controlled medications to Veterans in the community, to take opioid safety training. VA also strongly encourages providers to complete training regarding the military and Veteran culture.

The opioid safety and culture training were both developed by VA. Providers have 180 days, from the later of July 1, 2020 or the date of their CCN Network contract, to download and review the opioid safety handout by visiting https://train2serve.com/.

What Will the Training Cover?

The required opioid safety training is part of the VA Opioid Safety Initiative, a comprehensive strategy to reduce reliance on opioid medication and improve effectiveness and safety for Veterans. To meet the requirement, providers will register online at https://train2serve.com and download a two-page fact sheet.

The recommended military culture training emphasizes the importance of knowing the influence of military culture in a health care setting to help improve treatment outcomes for Veterans. According to VA, Veterans seen by culturally informed providers reported they were more satisfied with their visit, therefore more comfortable seeking and sharing information about their health care.

What Happens if Providers Don’t Take the Training?

Each individual TriWest provider with a DEA number must register to download and review the opioid safety handout. Providers who do not take the VA-mandated opioid training within the designated timeframe will stop receiving new Veteran referrals until they complete the training.

Next Steps – Take the Training!

To register and download VA’s opioid safety requirements:

  1. Visit https://train2serve.com.
  2. Select “Register Now”.
  3. Complete the registration process.
  4. Download the Opioid Safety Initiative information.

TriWest thanks its network providers for supporting the important mission to care for our nation’s Veterans.

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VA Prohibits Solicitation of Veterans

Network providers are not permitted to solicit the Department of Veterans Affairs (VA) or Veterans for referrals.

A provision under provider contracts with TriWest Healthcare Alliance specifically states, "Provider shall not advertise the award of the Agreement or these T & C in its commercial advertising in such a manner as to state or imply that the Department of Veterans Affairs endorses a product, project or commercial line of endeavor.""

Additionally, providers are not permitted to use any TriWest logos to promote partnership with TriWest.

Here is the official TriWest statement regarding provider requests for TriWest logo usage: “TriWest is not able to approve our logo usage in this situation. Our company has a strict non-endorsement policy because, in our contract with VA, TriWest is prohibited from marketing the VA’s program. Any marketing of the programs we administer for VA must be pre-approved directly by the Department of Veterans Affairs.”

If you are interested in sharing with your community that you serve Veterans, visit www.triwest.com/proudlycaring and download either a PDF print-ready sign or a website badge for online presence.

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Provider Handbook Updates

There are no planned changes to the PC3 or CCN handbooks in November 2020.

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Updated: 11/6/2020 11:10:44 AM