Provider Pulse – December 2024
Reminder: CCN Providers Must Have Authorization Prior to Rendering Care
As a reminder, any care provided to a Veteran patient under the Department of Veterans Affairs (VA) Community Care Network (CCN) should not be rendered without prior authorization from VA. If care is rendered without prior authorization, the Veteran cannot be billed for care.
If authorizations are submitted after rendering care to a Veteran and the Request for Service (RFS) is backdated, the authorization will not be approved.
To access and submit an RFS online, VA prefers that providers submit an RFS via HSRM.
- Visit the VA Storefront
- Click “Request and Coordinate Care” on the left-hand navigation bar under “For Providers.”
- Click “Request for Service (RFS) Requirements.”
- Navigate to the link to the RFS form at the bottom of the section.
- Send the RFS directly to your authorizing VA Medical Center (VAMC) via:
- VA's HSRM portal (preferable) or an EDI 278 transaction
- Direct messaging
- Secure email
- Secure online file exchange
- eHealth Exchange
Once approved, providers will receive an authorization letter from either the VA Medical Center (VAMC) or TriWest. Providers can also check the status of an RFS through VA's HSRM, EDI 278 transaction, or by calling the authorizing VAMC.
For more information, see the CCN Processes & Procedures page of the VA CCN Provider Handbook.
Ensuring Safe Opioid Use
The Opioid Safety Initiative (OSI) is a program designed to promote safe and effective care for Veterans, and it plays a crucial role in ensuring the safe use of opioids for all care, including behavioral health and cancer care.
OSI is a VA-mandated program, and as part of your participation agreement, providers must follow the policies outlined in the VA CCN Provider Handbook. Failure to meet the requirements of the program may result in corrective action or possible termination from participating in the program.
Prescribers are required to complete the OSI training, Community Care Provider Opioid Safety Initiative. Please note that TriWest also monitors compliance through clinical quality review processes and requires that providers respond to inquiries concerning opioid safety.
Key Clinical Information
- Research indicates that Veterans die from opiate-related overdoses at approximately twice the rate of non-Veterans. Assessment of risk factors is important in the Veteran population, especially in returning combat Veterans. A Veteran may present to primary care seeking relief from both physical and psychological pain.
- Psychological distress may lead to inappropriate use of opioid medications in patients with mental health disorders. Caution should be used in this high-risk population.
- Veterans with post-traumatic stress disorder (PTSD) are more likely to:
- Be prescribed opioids at higher doses.
- Receive opioids and sedative hypnotics (including benzodiazepines) concurrently. Combinations lead to increased risk of unintentional overdose.
For more information visit the OSI Toolkit or the Opioid Therapy pocket guide.
Thank you for continuing to prioritize the safety of our nation’s heroes through their treatment.
New Ruling Requires Digital Prescriptions for Eye Care Patients under CCN
A recent ruling now requires eye care providers rendering care under the Community Care Network (CCN) to issue a digital or electronic prescription for eyeglasses or contacts to patients if needed.
The Federal Trade Commission (FTC) has published a final rule to implement amendments to the Ophthalmic Practice Rules known as the Eyeglasses Rule, effective September 2024. This determines that if an eye exam was performed, and glasses or contacts are required, a copy of the script must be provided to the Veteran patient.
For more information visit the VA CCN Hearing Aids Eyeglass QRG.
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.
TriWest Network Starts Delivering Health Care Under TRICARE Jan. 1
The Department of Defense’s Defense Health Agency (DHA) has contracted with TriWest to support regional directors and military hospital commanders in delivering a seamless, integrated health care system across the new West Region starting Jan. 1, 2025.
TRICARE At-A-Glance
- TRICARE is the Department of Defense health benefit.
- TRICARE-eligible beneficiaries include enrolled active duty service members, active duty family members, National Guard and Reserve members and their families, military retirees and families, survivors and certain former spouses.
- The TRICARE West Region includes 26 states: Alaska, Arkansas, Arizona, California, Colorado, Hawaii, Idaho, Illinois, Iowa, Kansas, Louisiana, Minnesota, Missouri, Montana, Nebraska, Nevada, New Mexico, North Dakota, Oklahoma, Oregon, South Dakota, Texas, Utah, Washington, Wisconsin, and Wyoming.
Contracted with TriWest for TRICARE?
Prepare now for TriWest’s launch on Jan. 1, 2025, in the following ways:
- Register for a free Availity account. For TRICARE, TriWest has a unique TRICARE Payer Space on Availity. If you need help with registration or have questions about your Availity account, call Availity at 800-282-4548.
- Review the TriWest TRICARE West Region Provider Handbook. The TriWest TRICARE West Region Provider Handbook has information about program requirements, claims submission, eligibility, referrals and authorizations, and beneficiary out-of-pocket costs.
- Bookmark the new TRICARE website. Go to https://tricare.triwest.com to review the new site. More content will be added in the near future.
Want to Join the TriWest TRICARE West Region Network?
TriWest is now accepting interest forms from providers who wish to join.
- Apply to be a part of the TRICARE network! Visit JoinOurNetwork.TriWest.com.
- Fill out the Provider Contract Request form.
- Note: You will need your Federal Tax ID.
- Allow the TriWest team time to process requests and then you will be contacted by one of our provider relations representatives.
Once your contract is fully processed, you will receive a copy of your executed agreement.
Check out the Provider Contracting Q&A section on the TriWest site for more information.
Have questions about the TRICARE contract or how to join the TriWest provider network? Call 866-690-0885 to speak to a Provider Relations representative.
VA CCN Provider Handbook Updates