Provider Pulse
June 2020
Welcome to June
The June edition of the Provider Pulse showcases the start of the Department of Veterans Affairs (VA) Community Care Network (CCN) in Region 4 at initial VA medical centers. Other topics include a delay in the urgent care transition to Optum in CCN Regions 2 and 3; a new emergency care notification process, a new CCN Provider Handbook is now available; outpatient claims submissions during the calendar year; and updates to the PC3 Provider Handbook. Read all about these topics, and more, below.
In This Edition:
VA’s Community Care Network (CCN) Launched in Region 4
The new Community Care Network (CCN) is the Department of Veterans Affairs’ (VA) next generation of community care for eligible Veterans and a replacement for the Patient-Centered Community Care (PC3) program. Health care delivery under CCN in Region 4 began on June 8, 2020 in Montana and Eastern Colorado.
TriWest Healthcare Alliance, the third party administrator for CCN Region 4, created a fact sheet to give you an overview of CCN, a map of the CCN regions throughout the country, and a description of the key differences between PC3 and CCN by topic.
In addition, TriWest is offering a series of provider CCN training webinar sessions to help you prepare for health care deliver through CCN. Please register for these CCN webinar sessions, if you haven’t already, by taking the following steps:
- Log in to your account on Availity at www.availity.com.
(If you don’t have an account, register for one for free.) - Navigate to the TriWest Payer Space.
- Navigate to the TriWest Payer Space.
- Register for the full range of CCN webinar sessions at times that work for you.
Other Pertinent CCN Region 4 Information
- Providers must be fully contracted with TriWest as part of CCN to receive new referrals to care for eligible Veterans. Some providers may have received auto-amendments to their existing PC3 contracts that do not require a signature, while others need to sign an amendment or new CCN contract to continue treating Veterans under CCN. It is imperative that you sign your contract and submit it to TriWest so you can continue to receive new referrals to care for Veterans under CCN.
- Providers with existing PC3 referrals can complete the associated episode of care but any extensions of the episode of care must be done as a CCN network provider.
- The TriWest Provider portal at www.triwest.com/provider recently received a redesign to align with the new CCN. Information previously contained on the Provider portal is shifting to the TriWest Payer Space on Availity at www.availity.com. Availity is now your one-stop shop to access CCN training, as well as applications, quick reference guides, and the Provider Handbook.
- Availity will be your one-stop shop to access CCN trainings as well as applications, quick reference guides, the Provider Handbook, and news and announcements.
- Claims will continue to be sent to WPS Military and Veterans Health (WPS MVH).
- TriWest and VA intend to fully deploy CCN throughout all of CCN Region 4 by the end of August 2020.
For more information, please visit ccn.triwest.com.
Urgent Care Transition Delayed in CCN Regions 2 and 3
As VA continues its shift from PC3 to CCN across the country, Optum Public Sector Solutions, Inc. is increasing its network and claims responsibilities in CCN Regions 2 and 3.
The Urgent Care benefit responsibilities will transition to Optum in CCN Regions 2 and 3 no earlier than August 3, 2020. More details will be forthcoming. This encompasses both urgent care and urgent pharmacy prescription fills.
Visit the TriWest CCN transition page for more information regarding this transition period from PC3 to CCN.
New Emergency Care Notification Process
Effective June 8, 2020, providers treating Veterans who self-present to an emergency department should notify the Department of Veterans Affairs (VA) within 72 hours of the start of the episode of care. Community hospitals and providers should use the following methods to notify VA through a new centralized location, the Community Care Centralized Call Center, which is staffed and operated by Office of Community Care (OCC):
- Email: VHAEmergencyNotification@va.gov
- Phone: 844-72HRVHA or (844-724-7842)
Once notification is received and reviewed by VA using the eligibility criteria, treating community providers will receive authorization decision information and, if applicable, directions on how to submit claims.
The new process allows VA to assist the Veteran in coordinating necessary care or transfer, and helps ensure that the administrative and clinical requirements for VA to pay for the care are met. This process applies to providers participating in Patient-Centered Community Care (PC3) and the Community Care Network (CCN).
New CCN Provider Handbook Now Available!
As VA began rolling out the new CCN in Region 4 on June 8, TriWest posted the new CCN Provider Handbook on its Payer Space on Availity, as well as on ccn.triwest.com.
The Handbook offers providers a detailed look at CCN including:
- Provider training
- Claims
- Credentialing
- Urgent and emergency care
- Medical records
- Availity website
- VA Community Storefront
For more information, please visit ccn.triwest.com.
NEW! Submit Outpatient Claims Separately for Each Calendar Year
TriWest will no longer accept outpatient claims that span calendar years. You will need to submit a separate claim for services within each calendar year. For example, you should submit one claim with 2019 services and another claim for 2020 services.
TriWest is now following Medicare guidelines on this requirement.
For more information, please refer to Section 70.8.1 (Splitting Claims for Processing) of the Medicare Claims Processing Manual.
Provider Handbook Updates
Updates will be made to the PC3 Provider Handbook in July, adding a telehealth section that addresses videoconferencing and other technology platforms used for telehealth services. These services must meet the requirements of the Health Insurance Portability and Accountability Act (HIPAA) Privacy and Security Rules.