Provider Pulse – July 2021
Take a Look at Common Questions About CCN Claims and PGBA
As TriWest Healthcare Alliance recently transitioned to PGBA as its claims processor, there have been some common questions raised by providers regarding the enrollment process for Electronic Funds Transfer (EFT)/Electronic Remittance Advice (ERA) and Electronic Data Interchange (EDI).
Review the answers to the most frequently asked questions:
How do I fill out EDI, ERA or EFT enrollment forms?
For EDI, visit TriWest’s Payer Space on Availity.com and go to the Resources tab. Select PGBA EDI Provider Trading Partner Agreement for instructions and guidelines. For EFT/ERA, visit TriWest’s Payer Space on Availity.com and go to the Resources tab. Select PGBA EFT/ERA Enrollment Package for instructions and guidelines.
How do I find the EDI provider enrollment form on Availity.com?
Log in to Availity.com. Once you’ve logged in, select “Payer Spaces” drop-down menu from the top navigation. Choose TriWest Healthcare Alliance. Now you are in TriWest’s Payer Space. Next, select the Resources tab. Finally, scroll to and select PGBA EDI Provider Trading Partner Agreement.
When will my EDI, ERA or EFT enrollment be processed?
Allow at least two weeks for processing your enrollment before contacting PGBA for follow up.
Where are my claims? Why aren’t they on file or why is there no claim status on Availity.com?
Providers currently have a limited ability to view previously submitted claims with Availity’s Claims Status Lookup tool. TriWest is working to make improvements to the claims search experience for its providers. An enhanced search tool is anticipated to be implemented in mid-September. Additionally, new claims status will not be available until the enhanced search tool is implemented. To check claims status, call TriWest Claims Customer Service at 877-CCN-TRIW (877-226-8749) from 8 a.m. to 6 p.m. in your time zone, or visit Availity to use the secure “Chat with TriWest” feature.
When will I get paid?
TriWest strives to pay all clean claims within 30 days.
What is the mailing address to file paper claims?
TriWest VA CCN Claims
PO Box 108851
Florence, SC 29502-8851
For more answers to your claims-related questions, TriWest created a frequently asked questions document.
VA Offering Free COVID-19 Vaccinations
The Department of Veterans Affairs (VA) is reaching out to offer supplies of COVID-19 vaccines for your use. VA has enough vaccine to provide you, our community providers, an allocation to help us ensure all Americans can receive protection against COVID-19.
The vaccine VA would share is not restricted to use with Veterans. The vaccine can be used for ANY individual covered under the age authorization of the vaccine you receive.
If you are interested in receiving vaccine free of charge to you, please reach out to VHA Deputy Chief Consultant for Pharmacy Benefits Management, Jennifer L. Martin, at Jennifer.Martin23@va.gov.
Make Sure to Contact VAMC with Veteran’s Appointment Date
To ensure that your Veteran patients are seen in a timely manner and the appointment process goes smoothly, Community Care Network (CCN) providers are reminded to contact the VA Medical Center (VAMC) and advise when care for the Veteran actually starts.
By doing so, the VAMC or the TriWest customer service representative who is making the appointment can adjust the authorization dates. This action will help ensure the Veteran receives care in a timely manner, the entire episode of care is authorized, and eliminate possible claims issues.
If the admission date or outpatient episode of care timeframe and authorization dates do not match exactly, it will cause a denial for billing outside of the authorization dates.
Providers must have an approved referral/authorization from either a VAMC or TriWest before an appointment can be made. If care is rendered without the approved referral/authorization, there is a risk of not being reimbursed.
Check referral/authorization status using VA’s online HealthShare Referral Manager (HSRM), which VA uses to generate and submit referrals and authorizations to community providers.
For more information, refer to the Appointment Scheduling Quick Reference Guide or the Referral and Authorization Process Quick Reference Guide.
Mammography Screening is Still Important!
Mammography has proven to be effective in the early detection of breast cancer and in reducing the risk of advanced stages of the cancer. Although breast cancer screenings have decreased in recent times due to such factors as COVID-19, this should not prevent efforts to encourage women Veterans to get appropriate screenings. Remember to:
- Communicate information on the early detection of breast cancer and on mammography screening recommendations to all women patients
- At a minimum, refer a woman for mammography within 6 months after reaching the age of 50 years and every two years thereafter
A study posted on the U.S. Department of Health and Human Services website found that a reminder program that incorporated automated telephone calls improved repeat mammography screening as women were 1.5 times more like to complete a mammogram after receiving follow-up calls.
Provider Handbook Updates
There are no planned updates for the CCN Provider Handbook or the PC3 Provider Handbook.