VA’s agreement with Health Net Federal Services (Health Net) to extend the final date for filing initial claims to March 26, 2019, is just over two weeks away. To assure payment for services rendered, community providers must file initial claims for Health Net authorized services with Health Net by March 26, 2019.

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

For Additional Assistance:

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

To Check Claims Status: Community providers may continue and are encouraged to use www.availity.com to check status on claims submitted for Health Net-authorized services.

Again, community providers must be certain to  file all initial claims for Health Net authorized services with Health Net by March 26, 2019.

VA will now require a referral/authorization number to be submitted on all EDI and paper claim submissions that are pre-approved. The compliance date for this is June 2019, so please begin adjusting processes and systems now. This additional claim data will enable faster claims processing for authorized care. For paper claims, include this information in field 23 on a HCFA 1500 or field 63 on a UB-04. For EDI 837, Referral Number is Loop = 2300, Segment = REF*9F, Position = REF02 or Prior Authorization, Loop = 2300, Segment = REF*G1, Position = REF02.”

If you are a Home Health Agency billing with an OASIS Treatment number, you will continue to place the TAC in field 63a on a UB-04 and the VA referral/authorization number in field 63b. For EDI 837I, use the Prior Authorization segment for the TAC and the Referral Number segment for the VA referral/authorization number.

March 14, 2019:  VHA Office of Community Care Overview -  This 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.

March 28, 2019:  Post-traumatic Stress Disorder (PTSD) Assessment Treatment:  At the conclusion of this webinar attendees will be able to At the conclusion of this webinar attendees will be able to (1) identify the four symptom clusters of PTSD, (2) summarize the key points of the 2017 VA/DoD Clinical Practice Guideline (CPG) for PTSD, (3 )identify at least three evidence based treatments for PTSD, and (4) identify at least three National Center for PTSD resources and educational products. 

VA Staff register in TMS (ID 37421)

Community providers register in VHA TRAIN , (ID 1082571)

CALENDAR OF UPCOMING PROVIDER WEBINARS