Provider Pulse

February 2021

Welcome to February

February is known for Valentine’s Day and we at TriWest Healthcare Alliance (TriWest) love our Veterans and our providers for everything they have done and continue to do.

Veterans to Receive COVID-19 Vaccine Through VA Community Care

As the demand for COVID-19 vaccines continues to grow, the Department of Veterans Affairs (VA) is working closely with TriWest to provide Veterans another option for receiving a vaccination through the Community Care Network (CCN) in Region 4.

The VA health care benefit allows eligible Veterans to access COVID-19 vaccines in the community through one of the following three ways:

• Network retail pharmacy
• Urgent care facility
• Referred care visits

Vaccine supply remains limited throughout the country. Before receiving a COVID-19 vaccine, Veterans are advised by VA to:

• Consult local and state resources for vaccination availability, including VA facilities;
• Search for a retail pharmacy by using VA’s facility locator or an in-network CCN urgent care facility;
• Call the location to ensure supply is available; and
• Confirm whether an appointment is necessary.

Veterans are also encouraged to download a pharmacy information card to present to the provider at the time the vaccine is administered.

By enabling CCN providers and pharmacies to deliver free vaccine-only services to Veterans, in accordance with local, state or territorial vaccination plans, VA is directly contributing to the nation’s critical need for providing additional inoculation locations. This increase in access, however, does not give eligible

Veterans priority over others seeking vaccinations at those locations.

Please note that for Patient-Centered Community Care (PC3) in Alaska and the Pacific Islands, COVID-19 vaccines are available via urgent care and referred care visits only.

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New Way to Check Claims Status for Veterans

In its commitment to provide better service to its Community Care Network (CCN) providers, TriWest Healthcare Alliance (TriWest) has added a new enhancement for providers to check claims status for their Veteran patients: An Interactive Voice Response (IVR) system.

To check the status on claims, you can now use the CCN Contact Center phone number – 877-226-8749 (877-CCN-TRIW) – and follow the prompts.

Providers now have more options to check claims status or updates on CCN claims.

1. Newest option: TriWest’s IVR system. Access claims information by entering a key selection on a touchtone phone, or by voice command. Once the correct information is entered, you can retrieve data for an unlimited number of claims in one call. Note: If the IVR system cannot find the claim or you have more complex cases, the automated call will go to one of our knowledgeable customer service representatives.
2. Chat online with a live agent through Availity from 8 a.m. – 6 p.m. in your time zone, Monday through Friday.
3. Availity’s online app self-service option, available 24/7.
4. Call TriWest to speak with a CCN Contact Center representative at 877-226-8749 (877-CCN-TRIW).

On average, TriWest is processing and paying CCN claims to community providers in approximately 11 days, with over 98 percent processed and paid within 30 days.

For more information, refer to the IVR Quick Reference Guide.

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Avoid Claim Denials: Use Unique Procedure Code for Same Date of Service, Different Body Parts

Any provider who performs services that includes multiple body parts should submit each procedure code with the appropriate anatomic and/or surgical/procedure modifiers. Submitting the appropriate modifier will help avoid the denial of services as duplicates.

When a provider performs the same service on the same date of service on different body parts, the procedure codes must be filed with appropriate modifiers to indicate that the service is for a distinct and separate service and body part, even when billing on separate claims with separate authorizations. If not, the claim will be denied.

For more information regarding submitting claims to TriWest, refer to the Claims Submission Quick Reference Guide.

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TriWest Seeks Volunteers for Clinical Committees

TriWest is seeking CCN providers to participate in its clinical committees for peer review and credentialing.

TriWest holds virtual committee meetings monthly, and sends materials to participants in advance via encrypted email. Providers call in to the meeting to participate (some meetings include screen sharing). There is no travel required and providers are compensated for the hours they dedicate to this valuable work.

We are actively seeking participants in each of the following committees:

• Peer Review Committee – Responsible for oversight of the TriWest peer review process. Peer reviews are completed outside this committee by similar specialists, and the confirmed clinical quality concerns are discussed monthly. Cases include medical, surgical, behavioral, and integrated health. TriWest seeks community providers to review the peer review information and discuss appropriate improvement plans for quality of care with the committee. The completed peer reviews are provided prior to the meetings and may take several hours to review per month. Committee meetings are approximately two hours long and held in the early evening.
• Credentialing Committee – Evaluates and makes decisions regarding qualifications for the VA provider network in accordance with TriWest policy and URAC accreditation standards, including review of subcontracted provider networks.

Members are provided with the application packets of providers who have had actions on their licensure, malpractice or legal issues to review in advance of the meeting, which may require several hours to complete. The committee meets monthly on a Friday for one to two hours at midday.

It’s important that network providers have a say about the network they participate in. If you’re interested in serving as a committee member, please contact Pat Minnick, Vice President, Medical Management, Corporate Clinical Operations, at mminnick@triwest.com.

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VA Changes Reimbursement Policy: Spinal Decompression

VA has reviewed its policy relating to chiropractic care and will no longer reimburse spinal decompression Healthcare Common Procedure Coding System (HCPCS) code S9090 on VA standardized episodes of care (SEOC) with dates of service effective Jan. 1, 2021, and later.

Upon review, VA determined that there was insufficient evidence regarding unique benefits of this service to justify continued reimbursement for this code. Other types of lumbar traction can be used for care provided to Veterans and will be reimbursed by VA.

As with any non-emergent Veteran community care, the services must be authorized in advance.

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Check VAMC Before Prescribing Controlled Meds to Veterans

Many states recently implemented laws to require online/electronic prescriptions for controlled substances, effective Jan. 1, 2021. The e-prescribing method has become a challenge for many providers and Veterans, as VA Medical Centers (VAMC) are currently unable to accept the controlled substance prescriptions electronically.

VA is developing an e-prescribing tool that will comply with state regulations and permit the prescription, but it will not likely be live until September 2021. If a VAMC cannot receive prescriptions electronically, CCN providers should continue to provide a hard-copy script of a controlled medication.

Providers can contact the local VAMC if there are additional questions or concerns. TriWest will keep you updated regarding the timing of VA’s online prescribing tool.

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Remember to Monitor Veteran’s BMI

When ushering in a new year, resolutions regarding weight management are common. Recent studies indicate that obesity contributes to nearly 1 in 5 deaths in the U.S.

When providers regularly monitor a Veteran’s body mass index (BMI), they can help identify those who are at risk. In turn, they can tailor their advice and treatment to help Veterans maintain a healthier weight.

One quality measure regarding weight is also a focus area within the High Performing Provider (HPP) designation.

• BMI assessment of an adult, ages 18 - 74, documented during an outpatient visit.
  • Adult BMI - non-primary diagnosis ICD-10 Z68.51 – Z68.54: Z68.1 – Z68.45

TriWest processes data from claims, implements the HPP algorithm, and submits each provider’s HPP designation to the VA. HPP designations can fall into 3 potential categories:

• Yes – the provider meets the CCN HPP designation based on the quality and cost-efficient care criteria.
• No – the provider does not meet the CCN HPP designation based on the quality and cost-efficient care criteria.
• Unknown – meaning a default value and indicates that a CCN provider’s HPP designation has not been submitted to the Provider Profile Management System (PPMS).

Thank you for your commitment to delivering quality health care and your attention to the health and well-being of Veterans!

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Take VA Training on Referral Process, Earn Education Credit Hour

Community providers: Take advantage of VA’s live, knowledge-based training focused on Standardized Episodes of Care (SEOC) and Request for Services (RFS) processes. This webinar is scheduled for Feb. 25 at 1 p.m. EST.

Learn about the precertification process, your roles and responsibilities, and gain additional resources and tools to support the referral process. Participants will receive one credit hour with AAPA, ACCME, ACCME-NP, ACPE, ANCC, APA, ASWB, JA IPCE, NYSED, and SW.

Register and join the training session. For help, contact the VHA TRAIN Help Desk at vhatrain@va.gov.

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Provider Handbook Updates

The following changes have been made on Page 13:

Emergency care should be provided to any Veteran who self-presents to an emergency room (ER) seeking emergency care.

Community hospitals and providers treating Veterans who self-present to an emergency department are required to notify VA within (72) hours of Veterans presenting to the emergency room via the Emergency Care Reporting (ECR) portal, or by calling 844-72HRVHA (844-724-7842).

Providers will also be required to include a valid email address for decision correspondence when reporting emergency treatment.

VA will no longer include Veteran’s personal identification information in outgoing correspondence. Providers will need the notification identification number, assigned upon submission of reporting, to correlate authorization decisions to reported emergency events.

Questions? Contact the Emergency Treatment team at VHAOCCEmergencyCareTeam@va.gov.

More: Refer to the CCN Urgent Care & Emergency Care Quick Reference Guide.

There are no planned changes to the PC3 handbook for February 2021.

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