VA is pleased to provide two updates on community care under the VA MISSION Act, both of which were recently posted to VA’s official VAntagePoint blog and include a fact sheets with more detailed information. To read the articles and access the fact sheets, click one of the links below:
 General Information

• Article - VA MISSION Act – What is the latest on community care? (VAntage Point, 03/19/19)
• Fact Sheet - Veteran Community Care – General Information (VA MISSION Act of 2018)

 Eligibility

• VA MISSION Act: Will you be eligible for community care? (VAntage Point, 04/09/19)
• Fact Sheet: Veteran Community Care – Eligibility (VA MISSION Act of 2018)

 For more information about the VA MISSION Act and recent information, please see the   resources listed below:

• MISSION ACT 101:  How the law will improve VA’s ability to delivery health care to Veterans (VAntage Point, 02/11/19)
• VA MISSION Act Website

VA requires the use of the National Provider Identifier (NPI) for all providers conducting business with VA including all inbound medical, dental and pharmacy transactions. All Health Insurance Portability and Accountability Act (HIPAA)-covered health care providers who electronically bill for services to VA programs, or submit other electronic transactions through VA’s clearinghouse, need an NPI.

Providers can apply for cost-free NPIs in one of three ways:

1. Online through the National Plan and Provider Enumeration Systems (NPPES) at https://nppes.cms.hhs.gov/#/.
2. Through any Electronic File Interchange Organization (EFIO); arrange an agreement allowing the EFIO to submit application data on behalf of the provider. For more information visit: https://www.cms.gov/Regulations-and-Guidance/Administrative-Simplification/NationalProvIdentStand/efi.html.
3. Download and complete a copy of the paper NIP Application/Updates Form (CMS-10114) at http://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/downloads/CMS10114.pdf. Mail completed, signed forms to the NPI Enumerator.

                                             Mailing Address:
                                                     NPI Enumerator
                                                     P.O. Box 6059
                                                    Fargo, ND 58108-6059

Additional information about NPIs can be found at the Centers for Medicare & Medicaid Services website at https://www.cms.gov/Regulations-and-Guidance/Administrative-Simplification/Unique-Identifier/NPIs.html.

VA has unveiled a new series of literature reviews to help clinicians across the country put suicide prevention research into action.

This series, “From Science to Practice,” pairs findings on risk factors, protective factors, and other topics related to suicide with concrete steps that clinicians can take to best support their Veteran patients. Topics include:

• How loneliness can affect a Veteran’s mental health.
• How trauma experienced before military service can increase a Veteran’s risk for suicide.
• How military sexual trauma is a distinct risk factor for suicide, even after accounting for comorbid mental health conditions.

The “From Science to Practice” series describes a number of suicide risk and protective factors. No one risk or protective factor on its own causes or protects against suicide.

VA is committed to providing you with the latest research and will add to the “From Science to Practice” series, so be sure to check the website frequently. In addition, we encourage you to share this valuable resource with your colleagues and with partner organizations.

To learn more about the series and read the reviews, visit https://www.mentalhealth.va.gov/suicide_prevention/resources.asp.

We sincerely appreciate the work you do to support Veterans in your care. With your help, we can use the latest research to transform our work with Veterans and strengthen suicide prevention efforts across the country.

If you have any questions, please contact Dr. Susan Strickland, Associate Director for Research and Program Evaluation in the Office of Mental Health and Suicide Prevention, at susan.strickland@va.gov.  

New Paper Claims Process Coming in Mid-2019

VA is streamlining claims processing by converting paper-based claims to an electronic format. Beginning in mid-2019, community providers who submit paper claims to VA will be asked to mail claims directly to a new, central location. More information, to include the new address to which providers should begin mailing paper claims, will follow in the coming months.

VA strongly encourages providers to begin submitting claims electronically as soon as possible, as this is the most efficient way to adjudicate claims. Claims with supporting medical documentation do not need to be mailed together in order to simplify claims processing. Claims are now being separated from their attachments during the electronic conversion process. Community providers thus can submit claims electronically, even if supporting medical documentation is mailed in separately, in order to process the claim as quickly as possible. In the near future, VA will be adding a new capability to submit attachments electronically with electronic claims.

Note: The new claims intake system now automatically scans claims for compliance based on industry health care claim standards; therefore, community providers may experience an increase in rejections at the beginning of this transition. In order to minimize the likelihood of a claim rejection, community providers should ensure all required form fields are complete and correct. Below is the top claim rejection code and reason:

016: A missing/incomplete/invalid Social Security Number (SSN).

NOTE: Every claim requires a nine-digit numerical character entry (no alpha, punctuation or special characters). The SSN must be exactly 9 numeric characters—no exceptions.

For more information about how to prevent the most common paper claims rejections, please visit our Paper to Electronic Claims webpage. Here you will also find general guidance on the new paper claims submission process.

To enroll in electronic claim processing, community care providers should contact the VA clearinghouse, Change Healthcare by calling 866-371-9066 or visiting their website at https://www.changehealthcare.com/contact. Finally, if you have questions or comments related to the transition from paper to electronic claims initiative, please email P2EInquiries@va.gov.

VA is implementing a new community care claims processing software solution called Electronic Claims Adjudication Management System (eCAMS). The system modernizes the processing of claims received from community providers outside of VA’s Community Care Network (CCN).

eCAMS is an integral component of VA’s community care Information Technology (IT) architecture that streamlines claims processing while improving efficiency and standardization.  The system leverages auto-adjudication functionality and is reliant on valid data inputs to realize full automation capabilities.  With eCAMS, community care providers outside of the CCN will continue to submit claims much like they do today.

eCAMS is expected to be implemented nationwide between February and October 2019.

Requirements

With eCAMS, community providers must:

• Acquire a National Provider Identification (NPI) number and include that number on all claim submissions. Individuals or organizations can apply for NPIs through the CMS National Plan and Provider Enumeration System https://nppes.cms.hhs.gov.
• Include a complete 9-digit social security number for the Veteran on all claim submissions.
• Include the referral/authorization number on all electronic and paper claim submissions that are pre-approved. 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.
• Submit claims in accordance with National Uniform Billing Committee (NUBC) and National Uniform Claims Committee requirements (NUCC).

In addition, community providers are encouraged to:

• Submit HIPAA-compliant 837 EDI health care claims through VA’s clearinghouse, Change Healthcare.
• If you are interested in submitting claims through Change Healthcare, or if you need to change or cancel your enrollment, please contact Change Healthcare directly or visit their website.
• https://www.changehealthcare.com/
• Phone: 888-545-6127
• If you are not connected to Change Healthcare, contact your EDI clearinghouse and have our payer IDs added to their software system.
• ‘12115’ for medical claims/ERA
• ‘12116’ for dental claims/ERA
• ‘VAFEE’ for an eligibility inquiry transaction (270/271)

Support

 For more information on community care claims processing, visit the following website: https://www.va.gov/COMMUNITYCARE/providers/index.asp or email us at  VHA10D1D0providerfeedback@va.gov.

April 18, 2019:  VHA Office of Community Care Overview -  This webinar provides an overview of VA 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.

April 25, 2019:  Post-traumatic Stress Disorder (PTSD) Assessment Treatment Caring for Our Veterans who Experienced Military Sexual Trauma:  What Community Mental Health Providers Need to Know:  This webinar will provide a thorough overview of best practices in providing mental health treatment for Veterans who have experienced military sexual trauma (MST) and information about VA’s MST-related healthcare services. At the end of this webinar attendees will be able to define MST, identify how MST is similar to and different from other types of trauma, articulate common reactions after MST, including gender differences in reactions, best treatment practices and much more.

VA Staff register in TMS (ID 37881)
Community providers register in VHA TRAIN , (ID 1083828)

Go to the VA's community care Provider Education & Training  Resources webpage for a full listing of upcoming webinars and links to recordings of past webinars.