Issue 3 VHA Office of Community Care Monthly Provider Updates

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u s department of veterans affairs - veterans health administration - office of community care

VHA Office of Community Care
Monthly Provider Updates

Message from Dr. Kameron Matthews, Deputy Under Secretary for Health for Community Care

Dr. Kameron Matthews

Dear VA Community Providers,

On behalf of VA, I want to thank you for your commitment to caring for our Nation’s Veterans and for being dedicated partners to our efforts in securing their health care. We recognize the difficulties of our program—both past and current—and are aggressively implementing new business processes and IT solutions in 2019 that will make it easier for you to partner with VA. In addition, one of VA’s top priorities is implementation of the VA MISSION Act of 2018, which among other things, consolidates VA’s different community care programs—with different rules and requirements—into a single, consolidated program. We are committed to keeping you in the loop by sharing new information as it becomes available as well as hosting regular education opportunities. As a practicing clinician and former administrator at an academic health center, please consider me a direct resource should you have a question about community care today or in the future. We are making progress every day to make community care work better for Veterans, community providers and VA staff, and it’s our privilege to work alongside you in caring for Veterans.


Kameron Leigh Matthews, MD, JD, FAAFP
Deputy Under Secretary for Health for Community Care

Important Information related to Health Net Claims


The Department of Veterans Affairs (VA) contract with Health Net Federal Services (HNFS) ended on September 30, 2018.  VA is dedicated to working with providers to transition care coordination as seamlessly as possible and to communicate pertinent and timely information.

To assist you, our provider partners, during this transition time, we’ve outlined important information and key dates to note:

To Submit Claims: Community providers have until March 26, 2019 to submit initial claims to HNFS for payment for covered services that were rendered through September 30, 2018.

To Check Claims Status: Community providers can continue to use to check status on claims submitted for HNFS-authorized services.

Appeals, Denials, and Adjustments: will continue in accordance with the mutually agreed upon appeals process through January 30, 2020.

For Additional Assistance:

  • Providers may call the HNFS provider customer line at 844-728-1914 for PC3/VCP claims and authorization inquiries related to HNFS-authorized services or visit HNFS’ website at
  • Providers should address all outstanding PC3/VCP claims and authorization inquiries related to HNFS-authorized services claims directly with HNFS first by calling the HNFS provider customer line at 844-728-1914 or visiting HNFS’ website at
  • If after working with HNFS you are unable to get resolution for outstanding claims, contact OCC, Provider Relations & Services, Network Management at; a staff member will be assigned to work with you and HNFS toward resolution.

TriWest Expansion Community Provider Outreach


VA has reached an agreement with TriWest Healthcare Alliance (TriWest) to expand services to all regions, ensuring continuous access to community care for Veterans until the next generation of community care contracts are awarded.  VA will expand TriWest’s services to all regions by January 31, 2019. Usage of the TriWest network, in lieu of Individual Authorizations (IAs) (i.e., traditional fee care) or Veteran Choice Program (VCP) Provider Agreements (PAs) results in the following benefits:

  • Using the TriWest network and replacing the use of IAs or PAs, will not add to the VA claims processing backlog and instead claims will be processed by TriWest.
  • TriWest is paying 96 percent of clean claims within 30 days.
  • Less than 2 percent of community care referrals in TriWest’s current regions are returned for no community provider available.

To join the TriWest network as a PC3/VCP provider, a TriWest representative or network subcontractor may have contacted you or your office already about signing a TriWest contract.  If not, providers can request a TriWest contract at

To get more information about TriWest’s expansion providers may go to:

Emergency Medical Care for Veterans from Community Providers

Veteran Emergency Care

During a medical emergency, VA encourages Veterans to immediately seek care at the nearest medical facility, including community providers. While all VA care provided to Veterans through community providers must be authorized in advance, an exception is made for emergent situations, when this may not be feasible. As a result, there are certain VA processes and requirements associated with how it pays for unauthorized emergency medical care to Veterans.

For instance, there are different requirements and factors that affect the extent to which VA can cover emergency care services that depend on the Veteran’s service-connected/nonservice-connected condition(s), or if the care is related to a Veteran’s service-connected condition or nonservice-connected condition. Below are a couple of key points for when Veterans seek emergency care at a community provider:

  • It is very important that nearest VA medical facility is notified within 72 hours of a Veterans’ admission to a community care facility. This allows VA to assist the Veteran in coordinating necessary care or transfer and helps to ensure that the administrative and clinical requirements for VA to pay for the emergent care are met.
  • While Veterans should immediately seek care at the nearest medical facility during a medical emergency, the care provided is not necessarily paid for by VA.

For more information about how VA pays for unauthorized emergency medical care to Veterans, the following resources are available:

VHA Provider Monthly Webinars – December Offerings

VHA OCC Provider Webinar

December 20, 2018VHA Office of Community Care OverviewThis webinar provides an overview of Community Care programs and policies, focuses on how to file clean claims, and goes into other topics such as eligibility, referral, top rejection reasons and other provider issues.  Register for the webinar.

December 20, 2018:  Pain Management and the Opioid Safety Initiative in VHAIn this webinar, a VHA clinician will provide an overview of pain care transformation and the Opioid Safety Initiative (OSI) in the Veterans Health Administration that expanded systemwide in 2013 and is legislatively mandated by the Comprehensive Addiction and Recovery Act (CARA) in 2016.  VA Staff register in TMS (ID 37223) and community providers register in VHA TRAIN (ID 1081795).

OCC Webinar Cal

HealthShare Referral Manager Will Help Community Providers Serve Veterans


What is HealthShare Referral Manager (HSRM)?

HSRM is a commercial off-the-shelf solution that VA has selected to improve management of community care referrals and authorizations. HSRM streamlines referral and authorization management and improves information-sharing between community providers and VA.

Advantages to Community Providers Using HSRM

HSRM not only accelerates a Veteran’s ability to access care, but by working with community providers VA can ensure delivery of the highest possible quality of care Veterans. Below are a few examples of the benefits that community providers will see when they use HSRM:

  • Reduces turnaround time for processing referrals, providing care, and submitting claims
  • Facilitates medical documentation sharing, and enables community providers to upload required medical documentation for VA review
  • Improves workflow and reduces reliance on manual processes, such as telephone calls, emails, and faxes
  • Enables users to upload multiple types of essential medical documentation, images, notes and tests
  • Tracks communication with the patient using the “recording patient contact” functionality
  • Tracks standard episodes of care for Veterans, by monitoring and recording delivery and completion of care

HSRM will significantly improve the ability of community providers and VA to provide coordinated, consistent, and timely care for our Veterans. We hope that you will use this tool to better serve those who have served our Nation.

HSRM deployment will occur in a phased approach beginning in 2019. As HSRM is deployed to your local VA Medical Center you will receive details regarding how to register and obtain training for HSRM users at your site. In the meantime, to learn more about HSRM, please contact

Questions or comments about the newsletter may be sent to

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